| National Provider Identifier [NPI]: | 1518995620 |
| Last Name Of The Provider | KIM |
| First Name Of The Provider | JAN |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7253 AMBASSADOR RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BALTIMORE |
| Zip Code Of The Provider | 212442710 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 128 |
| Number Of Services | 14361 |
| Number Of Medicare Beneficiaries | 3852 |
| Total Submitted Charge Amount | 1142237.54 |
| Total Medicare Allowed Amount | 466055.99 |
| Total Medicare Payment Amount | 379809.79 |
| Total Medicare Standardized Payment Amount | 357384.41 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 8140 |
| Number Of Medicare Beneficiaries With Drug Services | 79 |
| Total Drug Submitted ChargeAmount | 1872.2 |
| Total Drug Medicare AllowedAmount | 1514.82 |
| Total Drug Medicare PaymentAmount | 1109.36 |
| Total Drug Medicare Standardized Payment Amount | 1109.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 127 |
| Number Of Medical Services | 6221 |
| Number Of Medicare Beneficiaries With Medical Services | 3852 |
| Total Medical Submitted Charge Amount | 1140365.34 |
| Total Medical Medicare Allowed Amount | 464541.17 |
| Total Medical Medicare Payment Amount | 378700.43 |
| Total Medical Medicare Standardized Payment Amount | 356275.05 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 426 |
| Number Of Beneficiaries Age 65 to 74 | 1673 |
| Number Of Beneficiaries Age 75 to 84 | 1145 |
| Number Of Beneficiaries Age Greater 84 | 608 |
| Number Of Female Beneficiaries | 2890 |
| Number Of Male Beneficiaries | 962 |
| Number Of Non Hispanic White Beneficiaries | 3105 |
| Number Of Black or African American Beneficiaries | 615 |
| Number Of AsianPacific Islander Beneficiaries | 38 |
| Number Of Hispanic Beneficiaries | 41 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 53 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3419 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 433 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3481 |