NPIMap

Individual provider Active NPI

Eliot S Light, MD

  • Family Medicine Physician
  • Pacific Grove, CA
National Provider Identifier
1942382577
Registry record updated Sep 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C40086 Issued in CA
Practice address
621 Forest Ave
Pacific Grove, CA 93950
Phone
(831) 649-1011
Fax
(831) 373-8201
NPI assigned
Oct 20, 2006
Last updated
Sep 30, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 30, 2020

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 C40086 CA Primary

Addresses

Primary practice location

621 Forest Ave
Pacific Grove, CA 93950

Mailing address

621 Forest Ave
Pacific Grove, CA 93950
Phone (831) 649-1011

Other identifiers 3

IdentifierTypeStateIssuer
770046058OtherBLUE SHIELD AND ALL OTHER
00G400860OtherCAMEDICARE PTAN
00G400860MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20100706000678 CA Practitioner - Family Practice 3072644137 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of California, Irvine, California College of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pacific Grove Family Medicine IncGroup PAC ID 4183877293, 2 clinicians

Practice addresses (Care Compare)

621 Forest Ave
Pacific Grove, CA 93950-4264
Phone (831) 649-1011

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
41.7 of 100Reported as individual
Quality
48.48
Improvement activities
0
Cost
74.36

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Grove Family Medicine, Inc. Family Medicine CurrentSince Nov 22, 2012 Accepting new patients
Community Hospital of the Monterey Peninsula PastSince Nov 22, 2012 Accepting new patients

Locations

621 Forest Ave
Pacific Grove, CA 93950
Phone (831) 372-2900

Interoperability endpoints

  • Direct secure messaging: eliot.light@12750807302148.direct.elationemr.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601424000000",
    "number": "1942382577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 FOREST AVE",
            "city": "PACIFIC GROVE",
            "state": "CA",
            "postal_code": "93950",
            "telephone_number": "831-649-1011",
            "fax_number": "831-373-8201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 FOREST AVE",
            "city": "PACIFIC GROVE",
            "state": "CA",
            "postal_code": "93950",
            "telephone_number": "831-649-1011",
            "fax_number": "831-373-8201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIGHT",
        "first_name": "ELIOT",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "C40086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD AND ALL OTHER",
            "identifier": "770046058",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "00G400860",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G400860",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pacific Grove, CA

Sources for this page

Verify at the official NPI Registry.