| National Provider Identifier [NPI]: | 1104856186 |
| Last Name Of The Provider | MATSUMOTO |
| First Name Of The Provider | TAKESHI |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 420 E. 3RD STREET |
| Street Address 2 Of The Provider | SUITE 606 |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 900131645 |
| 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 | 68 |
| Number Of Services | 12172 |
| Number Of Medicare Beneficiaries | 601 |
| Total Submitted Charge Amount | 829310 |
| Total Medicare Allowed Amount | 430614.36 |
| Total Medicare Payment Amount | 330207.99 |
| Total Medicare Standardized Payment Amount | 309222.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 639 |
| Number Of Medicare Beneficiaries With Drug Services | 382 |
| Total Drug Submitted ChargeAmount | 24145 |
| Total Drug Medicare AllowedAmount | 9684.15 |
| Total Drug Medicare PaymentAmount | 9303.8 |
| Total Drug Medicare Standardized Payment Amount | 9303.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 61 |
| Number Of Medical Services | 11533 |
| Number Of Medicare Beneficiaries With Medical Services | 601 |
| Total Medical Submitted Charge Amount | 805165 |
| Total Medical Medicare Allowed Amount | 420930.21 |
| Total Medical Medicare Payment Amount | 320904.19 |
| Total Medical Medicare Standardized Payment Amount | 299918.36 |
| Average Age Of Beneficiaries | 81 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | 172 |
| Number Of Beneficiaries Age Greater 84 | 262 |
| Number Of Female Beneficiaries | 334 |
| Number Of Male Beneficiaries | 267 |
| Number Of Non Hispanic White Beneficiaries | 14 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 521 |
| Number Of Hispanic Beneficiaries | 11 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 55 |
| Number Of Beneficiaries With Medicare Only Entitlement | 523 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 78 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 7 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 20 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 22 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0038 |