| National Provider Identifier [NPI]: | 1104938984 |
| Last Name Of The Provider | KIM |
| First Name Of The Provider | DONG |
| Middle Initial Of The Provider | O |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 400 N WALL ST |
| Street Address 2 Of The Provider | SUITE 410 |
| City Of The Provider | KANKAKEE |
| Zip Code Of The Provider | 609012940 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 121 |
| Number Of Services | 1438 |
| Number Of Medicare Beneficiaries | 589 |
| Total Submitted Charge Amount | 718526.11 |
| Total Medicare Allowed Amount | 276632.35 |
| Total Medicare Payment Amount | 213780.59 |
| Total Medicare Standardized Payment Amount | 213652.39 |
| 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 | 121 |
| Number Of Medical Services | 1438 |
| Number Of Medicare Beneficiaries With Medical Services | 589 |
| Total Medical Submitted Charge Amount | 718526.11 |
| Total Medical Medicare Allowed Amount | 276632.35 |
| Total Medical Medicare Payment Amount | 213780.59 |
| Total Medical Medicare Standardized Payment Amount | 213652.39 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 157 |
| Number Of Beneficiaries Age 65 to 74 | 223 |
| Number Of Beneficiaries Age 75 to 84 | 143 |
| Number Of Beneficiaries Age Greater 84 | 66 |
| Number Of Female Beneficiaries | 300 |
| Number Of Male Beneficiaries | 289 |
| Number Of Non Hispanic White Beneficiaries | 508 |
| Number Of Black or African American Beneficiaries | 62 |
| 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 | 371 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 218 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.9557 |