| National Provider Identifier [NPI]: | 1114146560 |
| Last Name Of The Provider | SHIM |
| First Name Of The Provider | ALDRIC |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2727 W OLYMPIC BLVD STE 101 |
| Street Address 2 Of The Provider | |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 900062641 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 158 |
| Number Of Services | 4276 |
| Number Of Medicare Beneficiaries | 2196 |
| Total Submitted Charge Amount | 906793 |
| Total Medicare Allowed Amount | 219405.94 |
| Total Medicare Payment Amount | 166305.28 |
| Total Medicare Standardized Payment Amount | 153116.3 |
| 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 | 158 |
| Number Of Medical Services | 4276 |
| Number Of Medicare Beneficiaries With Medical Services | 2196 |
| Total Medical Submitted Charge Amount | 906793 |
| Total Medical Medicare Allowed Amount | 219405.94 |
| Total Medical Medicare Payment Amount | 166305.28 |
| Total Medical Medicare Standardized Payment Amount | 153116.3 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 262 |
| Number Of Beneficiaries Age 65 to 74 | 548 |
| Number Of Beneficiaries Age 75 to 84 | 741 |
| Number Of Beneficiaries Age Greater 84 | 645 |
| Number Of Female Beneficiaries | 1295 |
| Number Of Male Beneficiaries | 901 |
| Number Of Non Hispanic White Beneficiaries | 239 |
| Number Of Black or African American Beneficiaries | 53 |
| Number Of AsianPacific Islander Beneficiaries | 1285 |
| Number Of Hispanic Beneficiaries | 578 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 307 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1889 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 42 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 49 |
| Percent Of With Chronic Kidney Disease | 56 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 43 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 64 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 74 |
| Percent Of With Osteoporosis | 26 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 16 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 2.9117 |