| National Provider Identifier [NPI]: | 1336183771 |
| Last Name Of The Provider | LIAO |
| First Name Of The Provider | JUSTIN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 520 SUPERIOR AVE |
| Street Address 2 Of The Provider | SUITE 360 |
| City Of The Provider | NEWPORT BEACH |
| Zip Code Of The Provider | 926633637 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 265 |
| Number Of Medicare Beneficiaries | 106 |
| Total Submitted Charge Amount | 26301 |
| Total Medicare Allowed Amount | 21195.12 |
| Total Medicare Payment Amount | 16370.32 |
| Total Medicare Standardized Payment Amount | 14675.13 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 35 |
| Number Of Medicare Beneficiaries With Drug Services | 30 |
| Total Drug Submitted ChargeAmount | 1381 |
| Total Drug Medicare AllowedAmount | 737.93 |
| Total Drug Medicare PaymentAmount | 721.14 |
| Total Drug Medicare Standardized Payment Amount | 721.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 18 |
| Number Of Medical Services | 230 |
| Number Of Medicare Beneficiaries With Medical Services | 106 |
| Total Medical Submitted Charge Amount | 24920 |
| Total Medical Medicare Allowed Amount | 20457.19 |
| Total Medical Medicare Payment Amount | 15649.18 |
| Total Medical Medicare Standardized Payment Amount | 13953.99 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 70 |
| Number Of Beneficiaries Age 75 to 84 | 22 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 34 |
| Number Of Male Beneficiaries | 72 |
| Number Of Non Hispanic White Beneficiaries | 93 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 106 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 0 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 15 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 48 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8407 |