| National Provider Identifier [NPI]: | 1871616391 |
| Last Name Of The Provider | KIM |
| First Name Of The Provider | SEUNG |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD., PH.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1000 N OAK AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MARSHFIELD |
| Zip Code Of The Provider | 544495703 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 14 |
| Number Of Services | 2870 |
| Number Of Medicare Beneficiaries | 1434 |
| Total Submitted Charge Amount | 1167253.2 |
| Total Medicare Allowed Amount | 189870.26 |
| Total Medicare Payment Amount | 139194.24 |
| Total Medicare Standardized Payment Amount | 99762.09 |
| 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 | 14 |
| Number Of Medical Services | 2870 |
| Number Of Medicare Beneficiaries With Medical Services | 1434 |
| Total Medical Submitted Charge Amount | 1167253.2 |
| Total Medical Medicare Allowed Amount | 189870.26 |
| Total Medical Medicare Payment Amount | 139194.24 |
| Total Medical Medicare Standardized Payment Amount | 99762.09 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 164 |
| Number Of Beneficiaries Age 65 to 74 | 564 |
| Number Of Beneficiaries Age 75 to 84 | 491 |
| Number Of Beneficiaries Age Greater 84 | 215 |
| Number Of Female Beneficiaries | 670 |
| Number Of Male Beneficiaries | 764 |
| Number Of Non Hispanic White Beneficiaries | 1394 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1176 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 258 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 1.1755 |