Loading...
NPI 1295790178 · Tamuning, GU · Internal Medicine Physician
Customize your policy alerts
Get alerted when relevant policies change without checking for updates manually.
Monitor payer policy activity
Doris Lim is a internal medicine physician provider located in Tamuning, Guam. This profile covers 5 Medicare and 5 Medicaid CPT/HCPCS procedure codes, with claims volume, average reimbursement, and total revenue by code, benchmarked against other providers billing the same services.
Provider details (source: NPPES NPI Registry)
| Field | Value |
|---|---|
| Entity Type | Individual |
| Organization | Doris Lim |
| Address | 241 Farenholt Avenue |
| City | Tamuning |
| State | GU |
| ZIP | 96913 |
| Taxonomy | Internal Medicine Physician |
| NPI Enumerated | April 20, 2006 |
Lifetime revenue by payer source (source: CMS Medicare & Medicaid claims data)
| Payer Source | Total Paid |
|---|---|
| Medicaid | $52.3K |
| Medicare | $51.1K |
This provider bills almost equally to Medicare and Medicaid by revenue, reporting $51.1K in lifetime Medicare revenue and $52.3K in lifetime Medicaid revenue, so the practice is effectively dual-payer at a similar scale rather than concentrated in a single program. Both payers contribute meaningfully to the practice’s overall activity, with Medicaid slightly larger by the rounded totals provided.
Medicare revenue is highly concentrated in office-based evaluation and management and preventive services: the precomputed top‑3 Medicare codes account for 95.9% of the provider’s Medicare revenue, led by 99213, 99214, and G0439. This mix (established patient visits at lower and moderate complexity plus Annual Wellness Visits) points to a classic ambulatory internal medicine workflow focused on chronic care management and preventive visits rather than procedural or specialty services.
Medicaid revenue shows an even stronger concentration: the top‑3 Medicaid codes account for 98.7% of the provider’s Medicaid revenue, dominated by 99213 and 99214 with a small contribution from vaccine administration codes (90471, 90686, 90688). The Medicaid code mix reinforces that the operation is primarily office‑visit driven primary care with occasional immunizations rather than a broad service line portfolio.
Volume and reimbursement per visit differ modestly between payers: for 99213 the provider billed 407 Medicare claims at $49 avg paid/claim and 741 Medicaid claims at $47 avg paid/claim, while for 99214 there were 239 Medicare claims at $71 avg paid/claim and 201 Medicaid claims at $81 avg paid/claim. These numbers indicate higher claim counts for common established‑patient visits on Medicaid but similar per‑claim payments for 99213 and slightly higher average Medicaid payment on 99214 in the rounded data provided.
National and state competitive standing is consistent with a modest ambulatory practice rather than a dominant center: for Medicare, 99213 ranks #38013 of 457151 providers nationally (92th percentile), indicating above‑average national volume for that single code, while 99214 (#128252 of 479517, 73th percentile) and G0439 (#36810 of 105855, 65th percentile) fall in the mid‑range. The pattern suggests stronger relative activity on routine established‑patient visits nationally, but overall the profile aligns with a small‑to‑midsized primary care operation rather than a high‑throughput specialty clinic.
Within the state Medicaid market the provider is a modest participant: 99213 ranks #26 of 48 providers in‑state (47th percentile) and 99214 ranks #25 of 35 (29th percentile), so the practice is near median or below median in Medicaid volume for these common E/M codes; vaccine codes (90471 and 90688) are at the low end of in‑state ranks. These state ranks imply limited competitive leverage on Medicaid relative to peers and a practice that serves a local patient panel without outsized market share.
The provider has long tenure on file, with NPI enumerated 2006-04-20 (~20 years ago), which supports interpretation of the billing profile as a stable, established ambulatory internal medicine practice rather than a newly formed clinic. Longevity combined with the concentrated E/M and wellness code mix is consistent with an ongoing primary care practice serving both Medicare and Medicaid populations.
Medicare revenue breakdown by CPT/HCPCS procedure code.
View: Bar Chart1 / 2
The CPT/HCPCS codes generating the most Medicare revenue for this provider.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 410 | $50 | $19.9K |
| 99214 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the… | 240 | $70 | $17K |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 90 | $140 | $12.3K |
| G0402 | Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment | 10 | $170 | $1.9K |
| 93000 | The provider records the electrical conduction of the heart to examine any abnormality in its functioning, based on signals from at least 12 leads, wires that connect the recording device to… | 20 | $10 | $200 |
How this provider's Medicare billing volume and revenue compare to other providers nationally and within its state, across 5 CPT/HCPCS codes.
Medicaid revenue breakdown by year and by CPT/HCPCS procedure code, including monthly billing trends and the top codes driving revenue.
View: By Year1 / 3
Every CPT/HCPCS code this provider has billed to Medicaid, with claims volume, average payment, and total revenue.
5 rows
| CPT/HCPCS Code | Description | Claims | Avg Paid | Revenue |
|---|---|---|---|---|
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 740 | $50 | $34.8K |
| 99214 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the… | 200 | $80 | $16.3K |
| 90471 | In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route. | 30 | $20 | $490 |
| 90686 | This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL… | 30 | $20 | $430 |
| 90688 | This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It uses split virus technology and is given as a 0.5 mL dose. | 10 | $20 | $250 |
How this provider's Medicaid billing volume and revenue compare to other Guam providers billing the same CPT/HCPCS codes.
Full comparison — all codes billed, vs. Guam median
5 rows
| CPT/HCPCS Code | Description | Rank | Provider Count | Median Claims | Avg Paid | Average Revenue |
|---|---|---|---|---|---|---|
| 99213 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a low level of medical decision making, and/or the… | 26 | 50 | 900 | $80 | $201.7K |
| 99214 | The provider sees an established patient for an office visit or other outpatient visit involving evaluation and management. The visit involves a moderate level of medical decision making, and/or the… | 25 | 40 | 630 | $90 | $172.1K |
| 90471 | In this procedure, the provider administers a live attenuated vaccine using a percutaneous, intradermal, subcutaneous, or intramuscular route. | 15 | 20 | 180 | $20 | $10.1K |
| 90688 | This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It uses split virus technology and is given as a 0.5 mL dose. | 10 | 10 | 70 | $10 | $1.2K |
| 90686 | This code represents a vaccine product administered into the muscle to protect against four strains of influenza (flu). It is preservative free, uses split virus technology, and is given as a 0.5 mL… | 8 | 10 | 100 | $1 | $580 |
Other providers in the same ZIP code as Doris Lim, ranked by combined Medicare and Medicaid revenue.
| Provider | State | Taxonomy | Medicare Revenue | Medicaid Revenue |
|---|---|---|---|---|
| Thomas Lee | GU | Dentist | $0 | $10.9M |
| Guam Memorial Hospital | GU | General Acute Care Hospital | $0 | $3.5M |
| Rsa - Tumon, LLC | GU | End-Stage Renal Disease (ESRD) Treatment Clinic/Center | $0 | $2.9M |
| Robert Yang | GU | Dentist | $0 | $2.4M |
| Antonio Garcia | GU | Pediatrics Physician | $0 | $2.2M |
| Ma Gladys Linsangan | GU | Pediatrics Physician | $0 | $2.2M |
| Ari Katerelos | GU | Radiation Oncology Physician | $2.1M | $0 |
| Guam X-ray | GU | Vascular & Interventional Radiology Physician | $0 | $2.1M |
| Sarah Clegg | GU | General Practice Dentistry | $0 | $1.7M |
| Peter Kh Go | GU | Surgery Physician | $152.8K | $1.5M |
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.