| National Provider Identifier [NPI]: | 1275813370 |
| Last Name Of The Provider | KIM |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | P.A. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1505 W. 17TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAN BERNARDINO |
| Zip Code Of The Provider | 924112661 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 462 |
| Number Of Medicare Beneficiaries | 182 |
| Total Submitted Charge Amount | 118000 |
| Total Medicare Allowed Amount | 30028.04 |
| Total Medicare Payment Amount | 21612.95 |
| Total Medicare Standardized Payment Amount | 23758.88 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 45 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 2760 |
| Total Drug Medicare AllowedAmount | 149 |
| Total Drug Medicare PaymentAmount | 114.17 |
| Total Drug Medicare Standardized Payment Amount | 114.17 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 417 |
| Number Of Medicare Beneficiaries With Medical Services | 182 |
| Total Medical Submitted Charge Amount | 115240 |
| Total Medical Medicare Allowed Amount | 29879.04 |
| Total Medical Medicare Payment Amount | 21498.78 |
| Total Medical Medicare Standardized Payment Amount | 23644.71 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 26 |
| Number Of Beneficiaries Age 65 to 74 | 79 |
| Number Of Beneficiaries Age 75 to 84 | 59 |
| Number Of Beneficiaries Age Greater 84 | 18 |
| Number Of Female Beneficiaries | 138 |
| Number Of Male Beneficiaries | 44 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 169 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 27 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 155 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 20 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4255 |