Sullivan Surgicenter,llc
NPI 1700854072 · Ambulatory Surgical Clinic/Center · Sullivan, IN
Enrolled with Medicare as Part B Supplier - Ambulatory Surgical Center · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1700854072
- Entity type
- Organization
- Primary specialty
- Ambulatory Surgical Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Custodio Lim, Ceo(812) 268-9000
- License
- 05-003633-1 (IN)
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure28% of score
20 yrs in NPPES registry
- Profile completeness28% of score
100% of core fields populated
- Practice footprint17% of score
1 documented practice location
- Medicare service volume (vs. specialty peers)28% of score
591 Medicare services, 2024 (ranked within specialty)
Medicare volume is ranked against active providers in the same specialty. Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
What this provider does (Medicare)
Based on Medicare fee-for-service claims, 2024; not all care is captured.
| Service (HCPCS) | Medicare services | Typical Medicare-allowed (2024) |
|---|---|---|
| Removal of Noncancer Skin Growth of Body, Arms, Or Legs, 1.1-2.0 Cm11402 | 103 | $65 |
| Removal of Cancer Skin Growth of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 1.1-2.0 Cm11642 | 100 | $137 |
| Removal of Noncancer Skin Growth of Scalp, Neck, Hands, Feet, Or Genitals, 1.1-2.0 Cm11422 | 68 | $56 |
| Removal of Noncancer Skin Growth of Face, Ears, Eyelids, Nose, Lips, Or Mouth, 1.1-2.0 Cm11442 | 59 | $82 |
| Removal of Cancer Skin Growth of Scalp, Neck, Hands, Feet, Or Genitals, 1.1-2.0 Cm11622 | 49 | $103 |
| Removal of Noncancer Skin Growth of Body, Arms, Or Legs, 0.6-1.0 Cm |
Practice location
Mailing address
Registry dates
- Enumerated
- 2006-03-10
- Last updated
- 2012-12-06
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.