Individual provider Active NPI

Jon Philip Lim, PT

  • Physical Therapist
  • Stevens Point, WI
National Provider Identifier
1770126856
Registry record updated Oct 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
14060 Issued in WI
Practice address
825 Whiting Ave
Stevens Point, WI 54481-5246
Phone
(715) 346-1374
NPI assigned
Oct 22, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 14060 WI Primary

Addresses

Primary practice location

825 Whiting Ave
Stevens Point, WI 54481-5246

Mailing address

825 Whiting Ave
Stevens Point, WI 54481-5246
Phone (715) 346-1374

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230706003595 NV Practitioner - Physical Therapist in Private Practice 9436518560 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Maxicare Therapy and Wellness of NevadaGroup PAC ID 4183033954, 8 clinicians

Practice addresses (Care Compare)

4510 S Eastern Ave
Suite 5
Las Vegas, NV 89119-6118
Phone 702381605363

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14060WIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Maxicare Therapy and Wellness of Nevada Physical Therapist CurrentSince May 1, 2023 Accepting new patients

Locations

4510 S Eastern Ave
Ste 5
Las Vegas, NV 89119
Phone (702) 381-6053

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1571702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571702400000",
    "number": "1770126856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 WHITING AVE",
            "city": "STEVENS POINT",
            "state": "WI",
            "postal_code": "544815246",
            "telephone_number": "715-346-1374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 WHITING AVE",
            "city": "STEVENS POINT",
            "state": "WI",
            "postal_code": "544815246",
            "telephone_number": "715-346-1374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIM",
        "first_name": "JON PHILIP",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-22",
        "last_updated": "2019-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "14060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stevens Point, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.