Individual provider Active NPI

Amy L Underwood-Jolly, M.D.

  • Internal Medicine Physician
  • Mission Viejo, CA
National Provider Identifier
1992783633
Registry record updated Nov 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A61697 Issued in CA
Practice address
26800 Crown Valley Pkwy
Suite 305
Mission Viejo, CA 92691-6384
Phone
(949) 364-6000
Fax
(949) 364-3213
NPI assigned
Jan 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A61697 CA Primary

Addresses

Primary practice location

26800 Crown Valley Pkwy
Suite 305
Mission Viejo, CA 92691-6384

Mailing address

26800 Crown Valley Pkwy Ste 330
Mission Viejo, CA 92691-6384
Phone (949) 364-6000

Other identifiers 1

IdentifierTypeStateIssuer
00A616970MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address aunderwoodjolly1373913@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050921000363 CA Practitioner - Internal Medicine 8527092386 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of California, Davis School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

100 E Valencia Mesa Dr
Suite 105
Fullerton, CA 92835-3816
Phone (714) 871-3006

1950 Sunny Crest Dr
Suite 2900
Fullerton, CA 92835-3641
Phone (714) 992-5350

24321 Avenida de la Carlota
Laguna Hills, CA 92653-3681
Phone (949) 204-3006

395 W Avenida Vista Hermosa
San Clemente, CA 92672-7720
Phone (949) 304-2117

831 Via Suerte
Suite 102
San Clemente, CA 92673-6531
Phone (949) 364-5600

Hospital & facility affiliations

  • Providence at Home With Compassus Home Health Orange County Home health agency, Anaheim, CA, CCN 057600
  • Providence Mission Hospital Hospital, Mission Viejo, CA, CCN 050567
  • Memorialcare Saddleback Medical Center Hospital, Laguna Hills, CA, CCN 050603

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation Current Accepting new patients
Mission Internal Medical Group, Inc. Current Accepting new patients
Providence Medical Foundation CurrentSince Jan 1, 2013 Accepting new patients
Providence Medical Foundation CurrentSince Jan 1, 2013 Accepting new patients
Mission Hospital Regional Medical Center Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

1950 Sunny Crest Dr
Ste 2900
Fullerton, CA 92835

26800 Crown Valley Pkwy
Ste 305
Mission Viejo, CA 92691
Phone (949) 364-6001

26800 Crown Valley Pkwy
Ste 300
Mission Viejo, CA 92691

26522 La Alameda
Ste 120
Mission Viejo, CA 92691
Phone (949) 282-1671

831 Via Suerte
Ste 102
San Clemente, CA 92673
Phone (949) 364-5600

665 Camino de los Mares
Ste 210
San Clemente, CA 92673
Phone (949) 240-6772

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636588800000",
    "number": "1992783633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26800 CROWN VALLEY PKWY STE 330",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916384",
            "telephone_number": "949-364-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26800 CROWN VALLEY PKWY",
            "address_2": "SUITE 305",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916384",
            "telephone_number": "949-364-6000",
            "fax_number": "949-364-3213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UNDERWOOD-JOLLY",
        "first_name": "AMY",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-04",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A61697",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A616970",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aunderwoodjolly1373913@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "26800 Crown Valley Pkwy",
            "city": "Mission Viejo",
            "state": "CA",
            "country_code": "US",
            "postal_code": "926916384",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mission Viejo, CA

Sources for this page

Verify at the official NPI Registry.