Custodio L. Lim, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

01035522 Issued in IN

Practice address

2235 Wabash Ave
Terre Haute, IN 47807-3330

Phone

(812) 234-5273

Fax

(812) 232-4714

NPI assigned

Aug 16, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

General Surgery

Education

Other, 1975

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

16.27 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

54.22

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Sullivan Surgicenter,LLC

  • Ambulatory Surgical Clinic/Center
  • Sullivan, IN
  • NPI 1700854072
  NPD (past) Authorized official
• Terre Haute Endocrinology and Diabetes LLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Terre Haute, IN
  • NPI 1528862588
  NPD (past)

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505433600000",
    "number": "1063404259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2235 WABASH AVE",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478073330",
            "telephone_number": "812-234-5273",
            "fax_number": "812-232-4714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2235 WABASH AVE",
            "city": "TERRE HAUTE",
            "state": "IN",
            "postal_code": "478073330",
            "telephone_number": "812-234-5273",
            "fax_number": "812-232-4714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIM",
        "first_name": "CUSTODIO",
        "middle_name": "L.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2017-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01035522",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100251710A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROVIDER NO.",
            "identifier": "000000087131",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Life Changes Mental Health and Addictions LLC
• Life Focus Psychological Consulting Services
• Bridgette Denise Likens, P. T.
• Robin Likens, N.P.
• Carmelita V Lim, PHYSICAL THERAPIST
• Jihye Lim, BCBA, LBA
• Ping Lin
• Lincare Inc
• Kelly Ann Foster Lindgren, OD
• Zoe Lindsley

• Surgery Physician in Terre Haute, IN
• Providers in Terre Haute, IN by specialty
• Surgery Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2017; 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.