Light Matter Solutions LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

LIGHT MATTER SOLUTIONS LLC

Practice address

333 E 2ND St
Richland Center, WI 53581-1914

Phone

(702) 453-3799

Fax

(702) 453-5741

NPI assigned

Feb 5, 2019

Organization subpart

No

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

Authorized official

Name

Jacob Kalliath, DONPI 1134569395

Title

Sole Owner

Phone

(256) 810-2308

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jacob Kalliath, D.O.

  • Internal Medicine Physician
  • Olympia Fields, IL
  • NPI 1134569395

  WI

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1549324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549324800000",
    "number": "1457816332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2660 CRIMSON CANYON DR STE 130",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891280846",
            "telephone_number": "702-453-3799",
            "fax_number": "702-453-5741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 E 2ND ST",
            "city": "RICHLAND CENTER",
            "state": "WI",
            "postal_code": "535811914",
            "telephone_number": "702-453-3799",
            "fax_number": "702-453-5741"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4455 Edison Lakes Pkwy",
            "address_purpose": "LOCATION",
            "city": "Mishawaka",
            "state": "IN",
            "postal_code": "465451414",
            "country_code": "US",
            "telephone_number": "702-453-3799",
            "fax_number": "702-453-5741",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIGHT MATTER SOLUTIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-05",
        "last_updated": "2019-02-05",
        "status": "A",
        "authorized_official_last_name": "KALLIATH",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "SOLE OWNER",
        "authorized_official_telephone_number": "256-810-2308",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sue Larson, LPC CSAC
• Jessica Rose Laue, RN
• Taryn A Lawler, DO
• Lindsey Marie Lawless, MS, PA-C
• Alyssa Lee
• Terrence J Lins, SAC
• Lori Knapp Richland, Inc.
• Bernadette Maglish
• Anita Lois Mainvel, CPM, LM
• Males Mainviel, NURSE PRACTITIONER

• Internal Medicine Physician in Richland Center, WI
• Providers in Richland Center, WI by specialty
• Internal Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.