| National Provider Identifier [NPI]: | 1609819226 |
| Last Name Of The Provider | PARK |
| First Name Of The Provider | SOO |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2325 18TH ST |
| Street Address 2 Of The Provider | SUITE 130 |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 472015387 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 70 |
| Number Of Services | 3561 |
| Number Of Medicare Beneficiaries | 1833 |
| Total Submitted Charge Amount | 913618.5 |
| Total Medicare Allowed Amount | 231274.1 |
| Total Medicare Payment Amount | 172010.57 |
| Total Medicare Standardized Payment Amount | 185155.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 44 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 2558.5 |
| Total Drug Medicare AllowedAmount | 2419.09 |
| Total Drug Medicare PaymentAmount | 1819.39 |
| Total Drug Medicare Standardized Payment Amount | 1819.39 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 68 |
| Number Of Medical Services | 3517 |
| Number Of Medicare Beneficiaries With Medical Services | 1833 |
| Total Medical Submitted Charge Amount | 911060 |
| Total Medical Medicare Allowed Amount | 228855.01 |
| Total Medical Medicare Payment Amount | 170191.18 |
| Total Medical Medicare Standardized Payment Amount | 183335.79 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 285 |
| Number Of Beneficiaries Age 65 to 74 | 727 |
| Number Of Beneficiaries Age 75 to 84 | 568 |
| Number Of Beneficiaries Age Greater 84 | 253 |
| Number Of Female Beneficiaries | 991 |
| Number Of Male Beneficiaries | 842 |
| Number Of Non Hispanic White Beneficiaries | 1779 |
| Number Of Black or African American Beneficiaries | 22 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1431 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 402 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.5801 |