| National Provider Identifier [NPI]: | 1659500973 |
| Last Name Of The Provider | PARK |
| First Name Of The Provider | LESLEY |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1327 LAKE POINTE PKWY |
| Street Address 2 Of The Provider | SUITE 525 |
| City Of The Provider | SUGAR LAND |
| Zip Code Of The Provider | 774784095 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 252 |
| Number Of Medicare Beneficiaries | 67 |
| Total Submitted Charge Amount | 43877.43 |
| Total Medicare Allowed Amount | 18988.64 |
| Total Medicare Payment Amount | 14813.24 |
| Total Medicare Standardized Payment Amount | 15538.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 28 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 2213.43 |
| Total Drug Medicare AllowedAmount | 841.06 |
| Total Drug Medicare PaymentAmount | 824.01 |
| Total Drug Medicare Standardized Payment Amount | 824.01 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 224 |
| Number Of Medicare Beneficiaries With Medical Services | 67 |
| Total Medical Submitted Charge Amount | 41664 |
| Total Medical Medicare Allowed Amount | 18147.58 |
| Total Medical Medicare Payment Amount | 13989.23 |
| Total Medical Medicare Standardized Payment Amount | 14714.6 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 40 |
| Number Of Beneficiaries Age 75 to 84 | 14 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 42 |
| Number Of Male Beneficiaries | 25 |
| Number Of Non Hispanic White Beneficiaries | 43 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1733 |