NPIMap

Individual provider Active NPI

Timothy G Gillum, MD

  • Specialist
  • Marion, IN
National Provider Identifier
1316994791
Registry record updated May 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
01055912A Issued in IN
Practice address
801 W Gardner Dr
Marion, IN 46952-1819
Phone
(765) 651-4278
Fax
(765) 664-6445
NPI assigned
May 30, 2006
Last updated
May 9, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 9, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 01055912A IN Primary

Addresses

Primary practice location

801 W Gardner Dr
Marion, IN 46952-1819

Mailing address

801 W Gardner Dr
Marion, IN 46952-1819
Phone (765) 651-4278

Other identifiers 1

IdentifierTypeStateIssuer
200434290AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20040824000006 IN Practitioner - OtolaryngologyPractitioner - Plastic and Reconstructive Surgery 4385618552 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
OtolaryngologyAlso: Plastic and Reconstructive Surgery
Education
University of Texas Medical School at San Antonio, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gillum Facial Plastic Surgery PCGroup PAC ID 3476527649, 2 clinicians

Practice addresses (Care Compare)

801 W Gardner Dr
Gillum Sinus and Allergy Institute
Marion, IN 46952-1819
Phone (765) 651-4278

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision45
Removal of tissue15
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy23

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01055912AINMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Gillum Facial Plastic Surgery, PC Specialist CurrentSince Mar 16, 2004 Accepting new patients
Grant Ambulatory Surgery Center, LLC Current Accepting new patients
Marion Physician Billing LLC Past Accepting new patients
Marion General Hospital Foundation, Inc. Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

330 N Wabash Ave
Ste 410
Marion, IN 46952
Phone (765) 651-4265

801 W Gardner Dr
Marion, IN 46952
Phone (765) 651-4278

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/6874/brand/1/csg/1/fhir/r4

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Otis R Bowen Center for Human Services IncPierceton, IN, CCN 154014 Hospital Corporate Director Nov 1, 2010

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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 4

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": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462752000000",
    "number": "1316994791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 W GARDNER DR",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469521819",
            "telephone_number": "765-651-4278",
            "fax_number": "765-664-6445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 W GARDNER DR",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469521819",
            "telephone_number": "765-651-4278",
            "fax_number": "765-664-6445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLUM",
        "first_name": "TIMOTHY",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-30",
        "last_updated": "2016-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IN",
            "license": "01055912A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200434290A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, IN

Sources for this page

Verify at the official NPI Registry.