| National Provider Identifier [NPI]: | 1184705097 |
| Last Name Of The Provider | LI |
| First Name Of The Provider | JIAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2225 US HIGHWAY 41 N |
| Street Address 2 Of The Provider | |
| City Of The Provider | TIFTON |
| Zip Code Of The Provider | 317942749 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 61 |
| Number Of Services | 2944 |
| Number Of Medicare Beneficiaries | 615 |
| Total Submitted Charge Amount | 710373.8 |
| Total Medicare Allowed Amount | 242989.4 |
| Total Medicare Payment Amount | 185974.54 |
| Total Medicare Standardized Payment Amount | 195273.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 114 |
| Number Of Medicare Beneficiaries With Drug Services | 30 |
| Total Drug Submitted ChargeAmount | 3616 |
| Total Drug Medicare AllowedAmount | 754.55 |
| Total Drug Medicare PaymentAmount | 697.46 |
| Total Drug Medicare Standardized Payment Amount | 697.46 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 55 |
| Number Of Medical Services | 2830 |
| Number Of Medicare Beneficiaries With Medical Services | 615 |
| Total Medical Submitted Charge Amount | 706757.8 |
| Total Medical Medicare Allowed Amount | 242234.85 |
| Total Medical Medicare Payment Amount | 185277.08 |
| Total Medical Medicare Standardized Payment Amount | 194576.37 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 140 |
| Number Of Beneficiaries Age 65 to 74 | 269 |
| Number Of Beneficiaries Age 75 to 84 | 163 |
| Number Of Beneficiaries Age Greater 84 | 43 |
| Number Of Female Beneficiaries | 334 |
| Number Of Male Beneficiaries | 281 |
| Number Of Non Hispanic White Beneficiaries | 493 |
| Number Of Black or African American Beneficiaries | 108 |
| 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 | 398 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 217 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 57 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.93 |