| National Provider Identifier [NPI]: | 1487764379 |
| Last Name Of The Provider | WADA |
| First Name Of The Provider | JERRY |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1505 WILSON TER |
| Street Address 2 Of The Provider | SUITE 370 |
| City Of The Provider | GLENDALE |
| Zip Code Of The Provider | 912064071 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 90 |
| Number Of Services | 105403 |
| Number Of Medicare Beneficiaries | 389 |
| Total Submitted Charge Amount | 1881819.7 |
| Total Medicare Allowed Amount | 970086.67 |
| Total Medicare Payment Amount | 747666.22 |
| Total Medicare Standardized Payment Amount | 721876.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 57 |
| Number Of Drug Services | 98902 |
| Number Of Medicare Beneficiaries With Drug Services | 101 |
| Total Drug Submitted ChargeAmount | 1230632.01 |
| Total Drug Medicare AllowedAmount | 616122.04 |
| Total Drug Medicare PaymentAmount | 477368.13 |
| Total Drug Medicare Standardized Payment Amount | 477368.13 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 6501 |
| Number Of Medicare Beneficiaries With Medical Services | 389 |
| Total Medical Submitted Charge Amount | 651187.69 |
| Total Medical Medicare Allowed Amount | 353964.63 |
| Total Medical Medicare Payment Amount | 270298.09 |
| Total Medical Medicare Standardized Payment Amount | 244508.09 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 57 |
| Number Of Beneficiaries Age 65 to 74 | 119 |
| Number Of Beneficiaries Age 75 to 84 | 132 |
| Number Of Beneficiaries Age Greater 84 | 81 |
| Number Of Female Beneficiaries | 228 |
| Number Of Male Beneficiaries | 161 |
| Number Of Non Hispanic White Beneficiaries | 267 |
| Number Of Black or African American Beneficiaries | 18 |
| Number Of AsianPacific Islander Beneficiaries | 35 |
| Number Of Hispanic Beneficiaries | 53 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 177 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 212 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 37 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.3538 |