Look up the most recent NPI and PECOS records

Amy L Underwood-Jolly

Internal Medicine

Allopathic & Osteopathic Physicians

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

PECOS Enrollment

This provider is enrolled in PECOS as AMY UNDERWOOD-JOLLY.

Based on the most recent information from CMS, provider Amy L Underwood-Jolly is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 33 days ago.

Profile Details

Provider ID
1992783633
Provider Type
Individual
Full Name
Underwood-Jolly, Amy L
Credential
M.D.

Gender
Female
Sole Proprietor
No
Enumeration Date
1/4/2006
Last Updated
11/11/2021

Contact Information

Practice Location

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

(949) 364-6000

(949) 364-3213

Mailing Location

26800 Crown Valley Pkwy Ste 330, Mission Viejo, CA 92691-6384

(949) 364-6000

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License A61697 California

Provider Identifiers

ID	Description	Issuer
ID 00A616970	Description Medicaid	Issuer Unlisted California

Amy L Underwood-Jolly

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Zebari, Diane Mary-Ann

Hauptman, Mark D

Finlayson, Erik

Nieto, Elizabeth Ann

Mission Center For Longevity & Aesthetic Medicine

Haghighat, Dennis P

Dna Medical Services Inc

Swadener, Nina C

Scheppach, James William

Moraghebi, Pardise