| National Provider Identifier [NPI]: | 1861506495 |
| Last Name Of The Provider | WAN |
| First Name Of The Provider | LORI |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7910 FROST STREET |
| Street Address 2 Of The Provider | SUITE 350 |
| City Of The Provider | SAN DIEGO |
| Zip Code Of The Provider | 92123 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 175 |
| Number Of Medicare Beneficiaries | 90 |
| Total Submitted Charge Amount | 24547 |
| Total Medicare Allowed Amount | 11819.08 |
| Total Medicare Payment Amount | 8935.46 |
| Total Medicare Standardized Payment Amount | 8605.39 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 21 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 1070 |
| Total Drug Medicare AllowedAmount | 636.1 |
| Total Drug Medicare PaymentAmount | 622.12 |
| Total Drug Medicare Standardized Payment Amount | 622.12 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 12 |
| Number Of Medical Services | 154 |
| Number Of Medicare Beneficiaries With Medical Services | 90 |
| Total Medical Submitted Charge Amount | 23477 |
| Total Medical Medicare Allowed Amount | 11182.98 |
| Total Medical Medicare Payment Amount | 8313.34 |
| Total Medical Medicare Standardized Payment Amount | 7983.27 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 30 |
| Number Of Beneficiaries Age 65 to 74 | 34 |
| Number Of Beneficiaries Age 75 to 84 | 14 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 61 |
| Number Of Male Beneficiaries | 29 |
| Number Of Non Hispanic White Beneficiaries | 45 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 36 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 54 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.8576 |