| National Provider Identifier [NPI]: | 1366485757 |
| Last Name Of The Provider | LAI |
| First Name Of The Provider | JIM |
| 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 | 4929 VAN NUYS BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SHERMAN OAKS |
| Zip Code Of The Provider | 914031702 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 90 |
| Number Of Services | 2886 |
| Number Of Medicare Beneficiaries | 1228 |
| Total Submitted Charge Amount | 1048094 |
| Total Medicare Allowed Amount | 250871.11 |
| Total Medicare Payment Amount | 192991.14 |
| Total Medicare Standardized Payment Amount | 184150.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 90 |
| Number Of Medical Services | 2886 |
| Number Of Medicare Beneficiaries With Medical Services | 1228 |
| Total Medical Submitted Charge Amount | 1048094 |
| Total Medical Medicare Allowed Amount | 250871.11 |
| Total Medical Medicare Payment Amount | 192991.14 |
| Total Medical Medicare Standardized Payment Amount | 184150.84 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 163 |
| Number Of Beneficiaries Age 65 to 74 | 292 |
| Number Of Beneficiaries Age 75 to 84 | 371 |
| Number Of Beneficiaries Age Greater 84 | 402 |
| Number Of Female Beneficiaries | 723 |
| Number Of Male Beneficiaries | 505 |
| Number Of Non Hispanic White Beneficiaries | 976 |
| Number Of Black or African American Beneficiaries | 46 |
| Number Of AsianPacific Islander Beneficiaries | 58 |
| Number Of Hispanic Beneficiaries | 115 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 652 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 576 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 32 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 64 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 15 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.3108 |