1. Home
  2. Directory
  3. Washington
  4. Richland
  5. Obstetrics Gynecology
  6. NPI Profile

HIPOLITO MANCE CUSTODIO III M.D.
NPI 1225244379
Obstetrics & Gynecology in Richland, WA

Active since May 15, 2007PECOS EnrolledAccepts Medicare Assignment
83.05/100
CMS Quality Rating
945 GOETHALS DR, SUITE 200, RICHLAND, WA 99352(509) 942-2555(509) 942-2340 Get Directions Write a Review

NPPES record last updated: May 10, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 10, 2021, Jul 23, 2019 (2 updates tracked since 2019).

About Hipolito Mance Custodio Iii M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HIPOLITO MANCE CUSTODIO III M.D. (NPI 1225244379) is an individual obstetrics & gynecology provider in Richland, Washington, licensed in Washington (MD60074660) and active in the NPI registry since May 2007. He is enrolled in Medicare PECOS, is affiliated with Kadlec Regional Medical Center, and is a graduate of Other (2001).

NPPES Registry Identity

NPI1225244379
Entity TypeIndividualMale
Primary Taxonomy207V00000X
Provider Legal NameHIPOLITO MANCE CUSTODIO IIICredential: M.D.
Location Address945 GOETHALS DR, SUITE 200Richland, WA 99352-3552
Mailing Address550 Gage Blvd, Ste 101Richland, WA 99352-9532 · (509) 942-3627 · Fax (509) 627-2983
Phone(509) 942-2555
Fax(509) 942-2340
Sole ProprietorNo
Medical School CMSOtherGraduated 2001
Enumeration DateMay 15, 2007
Last NPPES UpdateMay 10, 20212 updates tracked since enumeration
NPPES CertifiedMay 10, 2021
✔ NPI 1225244379 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians
Taxonomy Code207V00000X
Licenses✔ Licensed in WA · MD60074660✔ Licensed in PA · MT186614
Definition
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
945 GOETHALS DR, Richland, WA 99352
Open in Google Maps ↗

Other Identifiers 2

Other0249026WA · Labor & Industries
Medicaid8544694WA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., PacificSource Health Plans, Premera Blue Cross Blue Shield of Alaska and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Hipolito Mance Custodio Iii M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID345394805
PECOS Enrollment IDI20260421004259
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Kadlec Regional Medical Center

Acute Care Hospitals · Richland, WA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number500058
Location888 Swift BlvdRichland, WA 99352 · Benton County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 99352 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$130.99 typical visit price
range $57.27 – $172.80
Typical copayment $32.74 (range $14.31 – $43.20)
Most-billed visit code 99204
Established Patient
$71.29 typical visit price
range $18.56 – $141.11
Typical copayment $17.82 (range $4.64 – $35.27)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

83.05/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Quality76.47
Promoting Interoperability100
Improvement Activities40
Cost67.03

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. FREDRICK JOSEPH BOWERS MD
Specialist
945 GOETHALS DR, STE 210
RICHLAND, WA 99352
Benton County (509) 946-5512
EKTA KHURANA, MD PLLC
Pediatrics (Hospice and Palliative Medicine)
945 GOETHALS DR, SUITE 310
RICHLAND, WA 99352
Benton County (509) 946-7332
MR. MATTHEW C LAWRENCE MD
Family Medicine
945 GOETHALS DR, STE 300
RICHLAND, WA 99352
Benton County (509) 943-3196
STACEY ANN HANRAHAN BSN, MN, ARNP
Nurse Practitioner (Family)
945 GOETHALS DR, SUITE 300
RICHLAND, WA 99352
Benton County (509) 943-3196
ASSOCIATED PHYSICIANS FOR WOMEN
Obstetrics & Gynecology
945 GOETHALS DR, SUITE 200
RICHLAND, WA 99352
Benton County (509) 943-0300
MR. ERICK B ISAACSON MD
Family Medicine
945 GOETHALS DR, STE 300
RICHLAND, WA 99352
Benton County (509) 943-3196
DAVID L MERKLEY MD
Family Medicine
945 GOETHALS DR, SUITE 300
RICHLAND, WA 99352
Benton County (509) 943-3196
MRS. SARAH HALL HALL M.S., C.G.C
Genetic Counselor, MS
945 GOETHALS DR, SUITE 220
RICHLAND, WA 99352
Benton County (509) 942-2529

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Hipolito Custodio's NPI number?

The NPI number for Hipolito Custodio is 1225244379. It was assigned to this individual provider in the NPPES registry on May 15, 2007.

Where is Hipolito Custodio located?

Hipolito Custodio practices at 945 Goethals Dr Suite 200, Richland, WA 99352. The listed phone number is (509) 942-2555.

What is Hipolito Custodio's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Is Hipolito Custodio enrolled in Medicare?

Yes. Hipolito Custodio is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Hipolito Custodio accept?

Health plans from Moda Health Plan, Inc., PacificSource Health Plans, Premera Blue Cross Blue Shield of Alaska and Providence Health Plan list Hipolito Custodio as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Hipolito Custodio affiliated with any hospitals?

According to CMS data, Hipolito Custodio is affiliated with Kadlec Regional Medical Center.

When was this NPI record last updated?

The NPPES record for Hipolito Custodio was last updated on May 10, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.