| National Provider Identifier [NPI]: | 1740226950 |
| Last Name Of The Provider | KIM |
| First Name Of The Provider | SAM |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 331 N YORK |
| Street Address 2 Of The Provider | |
| City Of The Provider | HATBORO |
| Zip Code Of The Provider | 190402033 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 58 |
| Number Of Services | 9139 |
| Number Of Medicare Beneficiaries | 798 |
| Total Submitted Charge Amount | 1178836 |
| Total Medicare Allowed Amount | 405972.13 |
| Total Medicare Payment Amount | 300135.54 |
| Total Medicare Standardized Payment Amount | 269847.7 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 29 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 395 |
| Total Drug Medicare AllowedAmount | 257.07 |
| Total Drug Medicare PaymentAmount | 198.71 |
| Total Drug Medicare Standardized Payment Amount | 198.71 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 56 |
| Number Of Medical Services | 9110 |
| Number Of Medicare Beneficiaries With Medical Services | 798 |
| Total Medical Submitted Charge Amount | 1178441 |
| Total Medical Medicare Allowed Amount | 405715.06 |
| Total Medical Medicare Payment Amount | 299936.83 |
| Total Medical Medicare Standardized Payment Amount | 269648.99 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 26 |
| Number Of Beneficiaries Age 65 to 74 | 406 |
| Number Of Beneficiaries Age 75 to 84 | 251 |
| Number Of Beneficiaries Age Greater 84 | 115 |
| Number Of Female Beneficiaries | 385 |
| Number Of Male Beneficiaries | 413 |
| Number Of Non Hispanic White Beneficiaries | 733 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 27 |
| Number Of Beneficiaries With Medicare Only Entitlement | 779 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 19 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 5 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9169 |