| National Provider Identifier [NPI]: | 1609870666 |
| Last Name Of The Provider | LO |
| First Name Of The Provider | SAMUEL |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | O.D., M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1441 KAPIOLANI BLVD |
| Street Address 2 Of The Provider | STE 418 |
| City Of The Provider | HONOLULU |
| Zip Code Of The Provider | 968144400 |
| State Code Of The Provider | HI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 2162 |
| Number Of Medicare Beneficiaries | 463 |
| Total Submitted Charge Amount | 881488.88 |
| Total Medicare Allowed Amount | 281870.53 |
| Total Medicare Payment Amount | 193571.29 |
| Total Medicare Standardized Payment Amount | 192987.96 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 50 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 55481.97 |
| Total Drug Medicare AllowedAmount | 34326.06 |
| Total Drug Medicare PaymentAmount | 26911.56 |
| Total Drug Medicare Standardized Payment Amount | 26911.56 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 2112 |
| Number Of Medicare Beneficiaries With Medical Services | 463 |
| Total Medical Submitted Charge Amount | 826006.91 |
| Total Medical Medicare Allowed Amount | 247544.47 |
| Total Medical Medicare Payment Amount | 166659.73 |
| Total Medical Medicare Standardized Payment Amount | 166076.4 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 211 |
| Number Of Beneficiaries Age 75 to 84 | 152 |
| Number Of Beneficiaries Age Greater 84 | 79 |
| Number Of Female Beneficiaries | 284 |
| Number Of Male Beneficiaries | 179 |
| Number Of Non Hispanic White Beneficiaries | 61 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 341 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 48 |
| Number Of Beneficiaries With Medicare Only Entitlement | 346 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 117 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 6 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 25 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0673 |