Scott Matthew Light, P.A.-C.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA10005254 Issued in WA

Practice address

1251 NE Elm St
Suite 1a
Prineville, OR 97754-1206

Phone

(541) 447-1680

Fax

(541) 447-4670

NPI assigned

Oct 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• High Desert Healthcare

  • Rural Health Clinic/Center
  • Prineville, OR
  • NPI 1477554921
  NPD (past)
• Grays Harbor Community Hospital

  • General Acute Care Hospital
  • Aberdeen, WA
  • NPI 1154378859
  NPD (past)

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329955200000",
    "number": "1679653745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "838 ESSEX AVE",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985202718",
            "telephone_number": "503-730-6719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1251 NE ELM ST",
            "address_2": "SUITE 1A",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "977541206",
            "telephone_number": "541-447-1680",
            "fax_number": "541-447-4670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIGHT",
        "first_name": "SCOTT",
        "middle_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2012-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA01153",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10005254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OREGON STATE LICENSE",
            "identifier": "PA01153",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "213187",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA LICENCE",
            "identifier": "PA10005254",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stepheni Lester, QMHA
• Susan Lynne Leversee, PHARM.D.
• Jaime Levine, MSW
• Serena Ann Lewis, CRM
• Liberation Pathways LLC
• Maddie Lindburg
• Victoria Emerald Little
• Ashley Maire Lofton, CRM
• James Howard Long, R. PH.
• Kenneth D Long

• Medical Physician Assistant in Prineville, OR
• Providers in Prineville, OR by specialty
• Medical Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.