NPIMap

Individual provider Active NPI

Ryan Eugene Light, MD

  • Family Medicine Physician
  • Chesapeake, VA
National Provider Identifier
1912136946
Registry record updated Sep 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0116021359 Issued in VA
Practice address
1100 Volvo Pkwy
Suite 100
Chesapeake, VA 23320-3341
Phone
(757) 389-5370
Fax
(757) 389-5381
NPI assigned
Jul 13, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 25, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0116021359 VA Primary

Addresses

Primary practice location

1100 Volvo Pkwy
Suite 100
Chesapeake, VA 23320-3341

Mailing address

860 Omni Blvd
Suite 303
Newport News, VA 23606-4430
Phone (757) 232-8769

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120516000392 VA Practitioner - Family Practice 5597928291 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Eastern Virginia Medical School, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1100 Volvo Pkwy
Suite 100
Chesapeake, VA 23320-3341
Phone (757) 389-5370

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0116021359VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tidewater Physicians Multispecialty Group PC Family Medicine CurrentSince May 1, 2012 Accepting new patients
Tidewater Physicians Multispecialty Group PC CurrentSince May 1, 2012 Accepting new patients

Locations

1100 Volvo Pkwy
Ste 100
Chesapeake, VA 23320
Phone (757) 389-5370

860 Omni Blvd
Newport News, VA 23606
Phone (757) 369-8138

729 Thimble Shoals Blvd
Newport News, VA 23606
Phone (757) 874-1077

704 Thimble Shoals Blvd
#30
Newport News, VA 23606
Phone (757) 595-4300

827 Diligence Dr
Ste 100
Newport News, VA 23606

860 Omni Blvd
Ste 303
Newport News, VA 23606
Phone (757) 232-8777

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BGFHDD

Organizations & group practices 2

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.

Hospital & facility affiliations 12

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": "1247443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348531200000",
    "number": "1912136946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "860 OMNI BLVD",
            "address_2": "SUITE 303",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236064430",
            "telephone_number": "757-232-8769",
            "fax_number": "757-232-8875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 VOLVO PKWY",
            "address_2": "SUITE 100",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233203341",
            "telephone_number": "757-389-5370",
            "fax_number": "757-389-5381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIGHT",
        "first_name": "RYAN",
        "middle_name": "EUGENE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-13",
        "last_updated": "2012-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0116021359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesapeake, VA

Sources for this page

Verify at the official NPI Registry.