Individual provider Active NPI

Mallory Michelle Light, CRNA

  • Certified Registered Nurse Anesthetist
  • Mattoon, IL
National Provider Identifier
1093385072
Registry record updated Feb 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
209-026738 Issued in IL
Practice address
1000 Health Center Dr
Mattoon, IL 61938-4644
Phone
(217) 258-2440
Fax
(217) 258-2186
NPI assigned
Jun 30, 2021
Last updated
Feb 20, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 209-026738 IL Primary
Certified Registered Nurse Anesthetist 367500000X 2023001550 MO

Addresses

Primary practice location

1000 Health Center Dr
Mattoon, IL 61938-4644

Mailing address

1005 Health Center Dr Ste 201
Mattoon, IL 61938-4653

Other practice location 1

1 Barnes Jewish Hospital Plz
Dept Anesthesiology
Saint Louis, MO 63110-1003
Phone (800) 862-9980

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230207000860 MO Practitioner - Certified Registered Nurse Anesthetist (Crna) 1355713082 Reassigns benefits to 1 organization
I20230417002883 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 1355713082 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

611 W Park St
Urbana, IL 61801-2500

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.96 of 100Reported as apm
Quality
69.5
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Medical Group CurrentSince Feb 3, 2025 Accepting new patients
Washington University CurrentSince Feb 1, 2023 Accepting new patients
Sarah Bush Lincoln Health Center Current Accepting new patients
Sarah Bush Lincoln Health Center CurrentSince Feb 6, 2023 Accepting new patients
Washington University CurrentSince Feb 1, 2023 Accepting new patients

Locations

1000 Health Center Dr
Mattoon, IL 61938
Phone (217) 258-2389

1005 Health Center Dr
Ste 201
Mattoon, IL 61938
Phone (217) 238-6055

101 Professional Plz
Mattoon, IL 61938
Phone (217) 238-3730

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

1 Barnes Jewish Hospital Plz
Saint Louis, MO 63110
Phone (314) 362-1700

1 Barnes Jewish Hospital Plz
#P
Saint Louis, MO 63110
Phone (618) 474-1074

4960 Childrens Pl
Fl 2
Saint Louis, MO 63110
Phone (314) 362-1520

660 S Euclid Ave
#8054
Saint Louis, MO 63110
Phone (314) 286-1045

Organizations & group practices 5

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

Hospital & facility affiliations 2

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": "1625011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676851200000",
    "number": "1093385072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 HEALTH CENTER DR STE 201",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619384653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HEALTH CENTER DR",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619384644",
            "telephone_number": "217-258-2440",
            "fax_number": "217-258-2186"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Barnes Jewish Hospital Plz",
            "address_2": "Dept Anesthesiology",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631101003",
            "country_code": "US",
            "telephone_number": "800-862-9980",
            "fax_number": "314-362-1185",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIGHT",
        "first_name": "MALLORY",
        "middle_name": "MICHELLE",
        "name_prefix": "Ms.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-30",
        "last_updated": "2023-02-20",
        "certification_date": "2023-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209-026738",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "2023001550",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "1 Barnes Jewish Hospital Plz",
            "address_2": "Dept Anesthesiology",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631101003",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mattoon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.