| National Provider Identifier [NPI]: | 1134180839 |
| Last Name Of The Provider | GAN-LIM |
| First Name Of The Provider | LEONARDO |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2440 PROFESSIONAL CT |
| Street Address 2 Of The Provider | SUITE 110 |
| City Of The Provider | LAS VEGAS |
| Zip Code Of The Provider | 891280835 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 61 |
| Number Of Services | 2809 |
| Number Of Medicare Beneficiaries | 353 |
| Total Submitted Charge Amount | 377894 |
| Total Medicare Allowed Amount | 296981.5 |
| Total Medicare Payment Amount | 218765 |
| Total Medicare Standardized Payment Amount | 215597.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 44 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 1225 |
| Total Drug Medicare AllowedAmount | 673.82 |
| Total Drug Medicare PaymentAmount | 646.01 |
| Total Drug Medicare Standardized Payment Amount | 646.01 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 55 |
| Number Of Medical Services | 2765 |
| Number Of Medicare Beneficiaries With Medical Services | 353 |
| Total Medical Submitted Charge Amount | 376669 |
| Total Medical Medicare Allowed Amount | 296307.68 |
| Total Medical Medicare Payment Amount | 218118.99 |
| Total Medical Medicare Standardized Payment Amount | 214951.57 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 24 |
| Number Of Beneficiaries Age 65 to 74 | 116 |
| Number Of Beneficiaries Age 75 to 84 | 132 |
| Number Of Beneficiaries Age Greater 84 | 81 |
| Number Of Female Beneficiaries | 212 |
| Number Of Male Beneficiaries | 141 |
| Number Of Non Hispanic White Beneficiaries | 223 |
| Number Of Black or African American Beneficiaries | 31 |
| Number Of AsianPacific Islander Beneficiaries | 48 |
| Number Of Hispanic Beneficiaries | 36 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 287 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 66 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.7383 |