Active NPI
Domica Shanta Light
- Case Management Agency
- Champaign, IL
National Provider Identifier
1972890499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Management Agency
- Practice address
- 202 W Park Ave
Champaign, IL 61820-3929 - Phone
- (217) 373-2430
- NPI assigned
- Jul 5, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Case Management Agency | 251B00000X | Primary |
Addresses
Primary practice location
202 W Park Ave
Champaign, IL 61820-3929
Mailing address
2602 Carrelton Dr
Champaign, IL 61821-4760
Phone (217) 848-2262
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309824000000",
"number": "1972890499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2602 CARRELTON DR",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618214760",
"telephone_number": "217-848-2262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 W PARK AVE",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618203929",
"telephone_number": "217-373-2430"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIGHT",
"first_name": "DOMICA",
"middle_name": "SHANTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-07-05",
"last_updated": "2011-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "251B00000X",
"taxonomy_group": "",
"desc": "Case Management",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.