| National Provider Identifier [NPI]: | 1356311823 |
| Last Name Of The Provider | KIM |
| First Name Of The Provider | ANTHONY |
| 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 | 4504 BOAT CLUB RD |
| Street Address 2 Of The Provider | SUITE 800 |
| City Of The Provider | FORT WORTH |
| Zip Code Of The Provider | 761357003 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 63 |
| Number Of Services | 1721 |
| Number Of Medicare Beneficiaries | 417 |
| Total Submitted Charge Amount | 226845 |
| Total Medicare Allowed Amount | 116432.37 |
| Total Medicare Payment Amount | 78958.19 |
| Total Medicare Standardized Payment Amount | 81700.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 175 |
| Number Of Medicare Beneficiaries With Drug Services | 130 |
| Total Drug Submitted ChargeAmount | 8879 |
| Total Drug Medicare AllowedAmount | 2819.15 |
| Total Drug Medicare PaymentAmount | 2593.16 |
| Total Drug Medicare Standardized Payment Amount | 2593.16 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 52 |
| Number Of Medical Services | 1546 |
| Number Of Medicare Beneficiaries With Medical Services | 415 |
| Total Medical Submitted Charge Amount | 217966 |
| Total Medical Medicare Allowed Amount | 113613.22 |
| Total Medical Medicare Payment Amount | 76365.03 |
| Total Medical Medicare Standardized Payment Amount | 79106.96 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 80 |
| Number Of Beneficiaries Age 65 to 74 | 205 |
| Number Of Beneficiaries Age 75 to 84 | 99 |
| Number Of Beneficiaries Age Greater 84 | 33 |
| Number Of Female Beneficiaries | 226 |
| Number Of Male Beneficiaries | 191 |
| Number Of Non Hispanic White Beneficiaries | 316 |
| Number Of Black or African American Beneficiaries | 21 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 61 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 318 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 99 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1435 |