Melanie Custer, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

70643-20 Issued in WI

Practice address

611 Veterans Ave Unit 106
West Bend, WI 53090-2559

Phone

(262) 353-4460

Fax

(262) 353-4461

NPI assigned

Mar 19, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pediatric Medicine

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Deaconess Clinic IncGroup PAC ID 3375610116, 411 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mcuster223938@direct.deaconess.com

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.

• Deaconess Clinic Inc.

  • Internal Medicine Physician
  • Evansville, IN
  • NPI 1619123585
  Medicare reassignment Care Compare group NPD
• Deaconess Clinic Inc

  • Pediatrics Physician
  • Washington, IN
  • NPI 1356132310
  NPD
• Deaconess Clinic Inc.

  • Family Medicine Physician
  • Evansville, IN
  • NPI 1871749184

  Pediatrics

  NPD
• Children's Medical Group

  dba Glendale Pediatrics

  • Pediatrics Physician
  • Glendale, WI
  • NPI 1134394471
  NPD (past)
• Children's Medical Group

  dba West Bend Pediatrics

  • Pediatrics Physician
  • West Bend, WI
  • NPI 1992171987
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612828800000",
    "number": "1053686493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 FINANCIAL PL",
            "address_2": "SUITE 100",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427014470",
            "telephone_number": "270-769-0110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 VETERANS AVE UNIT 106",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530902559",
            "telephone_number": "262-353-4460",
            "fax_number": "262-353-4461"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 SE 4th St",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477081607",
            "country_code": "US",
            "telephone_number": "812-426-9480",
            "fax_number": "812-426-9887",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "545 S Boehne Camp Rd",
            "address_purpose": "LOCATION",
            "city": "Evansville",
            "state": "IN",
            "postal_code": "477123703",
            "country_code": "US",
            "telephone_number": "812-426-9480",
            "fax_number": "812-426-9887",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4209 Gateway Blvd",
            "address_purpose": "LOCATION",
            "city": "Newburgh",
            "state": "IN",
            "postal_code": "476308900",
            "country_code": "US",
            "telephone_number": "812-842-2800",
            "fax_number": "812-842-2901",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CUSTER",
        "first_name": "MELANIE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-19",
        "last_updated": "2021-02-09",
        "certification_date": "2021-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "70643-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053686493",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Creating Roots Wellness LLC
• Danielle Jacqueline Creegan, M.S.
• Heather Cromb
• Peter Joshua Cronin, MD
• Chloe Cusack, MS SLP-CFY
• Mary Kathleen Cutler, RN
• Erica Czosnyka
• Kylie Dake, OTR/L
• Jesen Daniel
• Sara N. Daniel, M.S.W., L.C.S.W

• Pediatrics Physician in West Bend, WI
• Providers in West Bend, WI by specialty
• Pediatrics Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.