| National Provider Identifier [NPI]: | 1285647925 |
| Last Name Of The Provider | PARK |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7203 129TH AVE SE |
| Street Address 2 Of The Provider | STE 100 |
| City Of The Provider | NEWCASTLE |
| Zip Code Of The Provider | 980561412 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 497 |
| Number Of Medicare Beneficiaries | 154 |
| Total Submitted Charge Amount | 101674.4 |
| Total Medicare Allowed Amount | 41946.02 |
| Total Medicare Payment Amount | 29577.83 |
| Total Medicare Standardized Payment Amount | 28006.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 34 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 1437.4 |
| Total Drug Medicare AllowedAmount | 1208.98 |
| Total Drug Medicare PaymentAmount | 1182.29 |
| Total Drug Medicare Standardized Payment Amount | 1182.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 463 |
| Number Of Medicare Beneficiaries With Medical Services | 154 |
| Total Medical Submitted Charge Amount | 100237 |
| Total Medical Medicare Allowed Amount | 40737.04 |
| Total Medical Medicare Payment Amount | 28395.54 |
| Total Medical Medicare Standardized Payment Amount | 26824.57 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 17 |
| Number Of Beneficiaries Age 65 to 74 | 51 |
| Number Of Beneficiaries Age 75 to 84 | 58 |
| Number Of Beneficiaries Age Greater 84 | 28 |
| Number Of Female Beneficiaries | 69 |
| Number Of Male Beneficiaries | 85 |
| Number Of Non Hispanic White Beneficiaries | 134 |
| 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 | 125 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 29 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 27 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1232 |