National Provider Identifier [NPI]: |
1326136045 |
Last Name Of The Provider |
KIM |
First Name Of The Provider |
TODD |
Middle Initial Of The Provider |
K |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
9535 GARDEN GROVE BLVD |
Street Address 2 Of The Provider |
SUITE #104 |
City Of The Provider |
GARDEN GROVE |
Zip Code Of The Provider |
928441550 |
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 |
35 |
Number Of Services |
910 |
Number Of Medicare Beneficiaries |
152 |
Total Submitted Charge Amount |
152200 |
Total Medicare Allowed Amount |
75019.66 |
Total Medicare Payment Amount |
58559.83 |
Total Medicare Standardized Payment Amount |
53106.65 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
3 |
Number Of Drug Services |
78 |
Number Of Medicare Beneficiaries With Drug Services |
25 |
Total Drug Submitted ChargeAmount |
980 |
Total Drug Medicare AllowedAmount |
115.42 |
Total Drug Medicare PaymentAmount |
90.59 |
Total Drug Medicare Standardized Payment Amount |
90.59 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
32 |
Number Of Medical Services |
832 |
Number Of Medicare Beneficiaries With Medical Services |
152 |
Total Medical Submitted Charge Amount |
151220 |
Total Medical Medicare Allowed Amount |
74904.24 |
Total Medical Medicare Payment Amount |
58469.24 |
Total Medical Medicare Standardized Payment Amount |
53016.06 |
Average Age Of Beneficiaries |
76 |
Number Of Beneficiaries Age Less65 |
|
Number Of Beneficiaries Age 65 to 74 |
63 |
Number Of Beneficiaries Age 75 to 84 |
64 |
Number Of Beneficiaries Age Greater 84 |
|
Number Of Female Beneficiaries |
107 |
Number Of Male Beneficiaries |
45 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
19 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
133 |
Percent Of With Atrial Fibrillation |
|
Percent Of With Alzheimers Disease or Dementia |
17 |
Percent Of With Asthma |
|
Percent Of With Cancer |
|
Percent Of With Heart Failure |
24 |
Percent Of With Chronic Kidney Disease |
23 |
Percent Of With Chronic Obstructive Pulmonary Disease |
7 |
Percent Of With Depression |
14 |
Percent Of With Diabetes |
49 |
Percent Of With Hyperlipidemia |
70 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
32 |
Percent Of With Osteoporosis |
41 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
75 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.2542 |