| National Provider Identifier [NPI]: | 1124043765 |
| Last Name Of The Provider | KIM |
| First Name Of The Provider | CHOLL |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6719 ALVARADO RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAN DIEGO |
| Zip Code Of The Provider | 921205270 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 1186 |
| Number Of Medicare Beneficiaries | 396 |
| Total Submitted Charge Amount | 1414135.75 |
| Total Medicare Allowed Amount | 283984.04 |
| Total Medicare Payment Amount | 220828.49 |
| Total Medicare Standardized Payment Amount | 227702.95 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 54 |
| Number Of Medical Services | 1186 |
| Number Of Medicare Beneficiaries With Medical Services | 396 |
| Total Medical Submitted Charge Amount | 1414135.75 |
| Total Medical Medicare Allowed Amount | 283984.04 |
| Total Medical Medicare Payment Amount | 220828.49 |
| Total Medical Medicare Standardized Payment Amount | 227702.95 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 37 |
| Number Of Beneficiaries Age 65 to 74 | 198 |
| Number Of Beneficiaries Age 75 to 84 | 123 |
| Number Of Beneficiaries Age Greater 84 | 38 |
| Number Of Female Beneficiaries | 209 |
| Number Of Male Beneficiaries | 187 |
| Number Of Non Hispanic White Beneficiaries | 319 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 29 |
| Number Of Hispanic Beneficiaries | 26 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 11 |
| Number Of Beneficiaries With Medicare Only Entitlement | 339 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 57 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2113 |