| National Provider Identifier [NPI]: | 1518124536 |
| Last Name Of The Provider | KIM |
| First Name Of The Provider | GLORIA |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2020 SANTA MONICA BLVD |
| Street Address 2 Of The Provider | STE. 210 |
| City Of The Provider | SANTA MONICA |
| Zip Code Of The Provider | 904042023 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 857 |
| Number Of Medicare Beneficiaries | 213 |
| Total Submitted Charge Amount | 226157.53 |
| Total Medicare Allowed Amount | 76184.47 |
| Total Medicare Payment Amount | 53406.13 |
| Total Medicare Standardized Payment Amount | 50080.05 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 103 |
| Number Of Medicare Beneficiaries With Drug Services | 67 |
| Total Drug Submitted ChargeAmount | 10067.53 |
| Total Drug Medicare AllowedAmount | 3303.68 |
| Total Drug Medicare PaymentAmount | 3221.05 |
| Total Drug Medicare Standardized Payment Amount | 3221.05 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 754 |
| Number Of Medicare Beneficiaries With Medical Services | 213 |
| Total Medical Submitted Charge Amount | 216090 |
| Total Medical Medicare Allowed Amount | 72880.79 |
| Total Medical Medicare Payment Amount | 50185.08 |
| Total Medical Medicare Standardized Payment Amount | 46859 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 136 |
| Number Of Beneficiaries Age 75 to 84 | 47 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 172 |
| Number Of Male Beneficiaries | 41 |
| Number Of Non Hispanic White Beneficiaries | 129 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 49 |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 177 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 36 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 18 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9961 |