| National Provider Identifier [NPI]: | 1760468730 |
| Last Name Of The Provider | PARK |
| First Name Of The Provider | KIP |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5544 GREENWICH RD STE 200 |
| Street Address 2 Of The Provider | |
| City Of The Provider | VIRGINIA BEACH |
| Zip Code Of The Provider | 234626563 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 194 |
| Number Of Services | 5752 |
| Number Of Medicare Beneficiaries | 3828 |
| Total Submitted Charge Amount | 687019 |
| Total Medicare Allowed Amount | 185662.98 |
| Total Medicare Payment Amount | 140579.08 |
| Total Medicare Standardized Payment Amount | 145356.1 |
| 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 | 194 |
| Number Of Medical Services | 5752 |
| Number Of Medicare Beneficiaries With Medical Services | 3828 |
| Total Medical Submitted Charge Amount | 687019 |
| Total Medical Medicare Allowed Amount | 185662.98 |
| Total Medical Medicare Payment Amount | 140579.08 |
| Total Medical Medicare Standardized Payment Amount | 145356.1 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 766 |
| Number Of Beneficiaries Age 65 to 74 | 1384 |
| Number Of Beneficiaries Age 75 to 84 | 1056 |
| Number Of Beneficiaries Age Greater 84 | 622 |
| Number Of Female Beneficiaries | 2331 |
| Number Of Male Beneficiaries | 1497 |
| Number Of Non Hispanic White Beneficiaries | 2224 |
| Number Of Black or African American Beneficiaries | 1459 |
| Number Of AsianPacific Islander Beneficiaries | 54 |
| Number Of Hispanic Beneficiaries | 47 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2957 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 871 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.9385 |