| National Provider Identifier [NPI]: | 1659416584 |
| Last Name Of The Provider | SO |
| First Name Of The Provider | VANNARITH |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD, MPH |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1777 N BELLFLOWER BLVD |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | LONG BEACH |
| Zip Code Of The Provider | 908154013 |
| 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 | 37 |
| Number Of Services | 6086 |
| Number Of Medicare Beneficiaries | 847 |
| Total Submitted Charge Amount | 797033 |
| Total Medicare Allowed Amount | 634467.12 |
| Total Medicare Payment Amount | 488329.14 |
| Total Medicare Standardized Payment Amount | 456354.9 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 89 |
| Number Of Medicare Beneficiaries With Drug Services | 82 |
| Total Drug Submitted ChargeAmount | 3343 |
| Total Drug Medicare AllowedAmount | 2279.83 |
| Total Drug Medicare PaymentAmount | 2234.06 |
| Total Drug Medicare Standardized Payment Amount | 2234.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 5997 |
| Number Of Medicare Beneficiaries With Medical Services | 847 |
| Total Medical Submitted Charge Amount | 793690 |
| Total Medical Medicare Allowed Amount | 632187.29 |
| Total Medical Medicare Payment Amount | 486095.08 |
| Total Medical Medicare Standardized Payment Amount | 454120.84 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 319 |
| Number Of Beneficiaries Age 65 to 74 | 224 |
| Number Of Beneficiaries Age 75 to 84 | 172 |
| Number Of Beneficiaries Age Greater 84 | 132 |
| Number Of Female Beneficiaries | 431 |
| Number Of Male Beneficiaries | 416 |
| Number Of Non Hispanic White Beneficiaries | 447 |
| Number Of Black or African American Beneficiaries | 148 |
| Number Of AsianPacific Islander Beneficiaries | 100 |
| Number Of Hispanic Beneficiaries | 136 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 281 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 566 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 28 |
| Percent Of With Asthma | 21 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 37 |
| Percent Of With Depression | 55 |
| Percent Of With Diabetes | 53 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 40 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.415 |