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SAMUEL CLARK LIGHT DO
NPI 1609629518
Student in an Organized Health Care Education/Training Program in Raleigh, NC

Active since April 09, 2024PECOS Enrolled
3000 NEW BERN AVE, RALEIGH, NC 27610(919) 350-8000 Get Directions Write a Review

NPPES record last updated: July 3, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 3, 2024, Apr 11, 2024 (2 updates tracked since 2024).

About Samuel Clark Light Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAMUEL CLARK LIGHT DO (NPI 1609629518) is an individual student in an organized health care education/training program in Raleigh, North Carolina and active in the NPI registry since April 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1609629518
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameSAMUEL CLARK LIGHTCredential: DO
Location Address3000 NEW BERN AVERaleigh, NC 27610-1295
Mailing Address3000 New Bern AveRaleigh, NC 27610-1295 · (919) 350-8000
Phone(919) 350-8000
Sole ProprietorNo
Enumeration DateApril 9, 2024
Last NPPES UpdateJuly 3, 20242 updates tracked since enumeration
NPPES CertifiedJuly 3, 2024
✔ NPI 1609629518 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
3000 NEW BERN AVE, Raleigh, NC 27610
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Samuel Clark Light Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JILL M PAPPALARDI M.D.
Hospitalist
3000 NEW BERN AVE
RALEIGH, NC 27610
Wake County (919) 350-8000
MS. TONYA R GABLE LCSW
Social Worker (Clinical)
3000 NEW BERN AVE
RALEIGH, NC 27610
Wake County (919) 350-4163
MS. HOLLY H HEAD P-LCSW
Social Worker (Clinical)
3000 NEW BERN AVE
RALEIGH, NC 27610
Wake County (919) 350-7445
KATHLEEN VALERIE FIGLER CFNP
Nurse Practitioner (Family)
3000 NEW BERN AVE
RALEIGH, NC 27610
Wake County (919) 350-8779
MRS. BAILEY HARDY UNDERHILL PA-C
Physician Assistant (Medical)
3000 NEW BERN AVE
RALEIGH, NC 27610
Wake County (919) 350-8000
DR. SERDAL AKTOLGA M.D.
Internal Medicine
3000 NEW BERN AVE
RALEIGH, NC 27610
Wake County (919) 350-8000
JESSICA CARTEE HOWE MS-CCC/SLP
Speech-Language Pathologist
3000 NEW BERN AVE
RALEIGH, NC 27610
Wake County (919) 684-6271
ADAM PETER LISEWSKI OT
Occupational Therapist
3000 NEW BERN AVE
RALEIGH, NC 27610
Wake County (919) 350-8000

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Samuel Light's NPI number?

The NPI number for Samuel Light is 1609629518. It was assigned to this individual provider in the NPPES registry on April 9, 2024.

Where is Samuel Light located?

Samuel Light practices at 3000 New Bern Ave, Raleigh, NC 27610. The listed phone number is (919) 350-8000.

What is Samuel Light's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Samuel Light enrolled in Medicare?

Yes. Samuel Light is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Samuel Light was last updated on July 3, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.