Active NPI
Diane Louise Light, D.O.
- Surgery Physician
- Jefferson City, MO
National Provider Identifier
1831185651
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 100575
- Practice address
- 1125 Madison St
Jefferson City, MO 65101-5227 - Phone
- (573) 632-5700
- Fax
- (573) 632-5720
- NPI assigned
- Sep 27, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 100575 | MO | Primary |
Addresses
Primary practice location
1125 Madison St
Jefferson City, MO 65101-5227
Mailing address
1125 Madison St
PO Box 1107
Jefferson City, MO 65101-5227
Phone (573) 632-5700
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020038004 | Other | MO | RAILROAD MEDICARE |
| 243392222 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080911000291 | MO | Practitioner - General Surgery | 7911097365 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 100575 | MO | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344556800000",
"number": "1831185651",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1125 MADISON ST",
"address_2": "PO BOX 1107",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651015227",
"telephone_number": "573-632-5700",
"fax_number": "573-632-5720"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1125 MADISON ST",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651015227",
"telephone_number": "573-632-5700",
"fax_number": "573-632-5720"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIGHT",
"first_name": "DIANE",
"middle_name": "LOUISE",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-27",
"last_updated": "2012-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MO",
"license": "100575",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "020038004",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "243392222",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jefferson City, MO
- LHCG Cxlvi, LLC (Central Missouri Home Health)
- LHCG Cxlviii, LLC (Central Missouri Hospice)
- LHCG Cxxxxiii, LLC (Capital Region Home Health)
- Hannah Elizabeth Libbert, DPT
- Lifesong for Growth and Wellness LLC
- Lighthouse of Hope & Healing, LLC
- Jill M. Lillard, MA LPC
- Richard P Lillard, PSY.D.
- James C Lin, M.D.
- Lincare Inc.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.