| National Provider Identifier [NPI]: | 1770557506 |
| Last Name Of The Provider | KIM |
| First Name Of The Provider | VLADLEN |
| 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 | 5187 MAYFIELD RD |
| Street Address 2 Of The Provider | STE 102 |
| City Of The Provider | LYNDHURST |
| Zip Code Of The Provider | 44124 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 138 |
| Number Of Services | 10077 |
| Number Of Medicare Beneficiaries | 772 |
| Total Submitted Charge Amount | 654874.5 |
| Total Medicare Allowed Amount | 377621.6 |
| Total Medicare Payment Amount | 284089.85 |
| Total Medicare Standardized Payment Amount | 292516.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 21 |
| Number Of Drug Services | 1708 |
| Number Of Medicare Beneficiaries With Drug Services | 262 |
| Total Drug Submitted ChargeAmount | 43390 |
| Total Drug Medicare AllowedAmount | 27173.48 |
| Total Drug Medicare PaymentAmount | 22916.53 |
| Total Drug Medicare Standardized Payment Amount | 22916.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 117 |
| Number Of Medical Services | 8369 |
| Number Of Medicare Beneficiaries With Medical Services | 772 |
| Total Medical Submitted Charge Amount | 611484.5 |
| Total Medical Medicare Allowed Amount | 350448.12 |
| Total Medical Medicare Payment Amount | 261173.32 |
| Total Medical Medicare Standardized Payment Amount | 269600 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 98 |
| Number Of Beneficiaries Age 65 to 74 | 265 |
| Number Of Beneficiaries Age 75 to 84 | 260 |
| Number Of Beneficiaries Age Greater 84 | 149 |
| Number Of Female Beneficiaries | 439 |
| Number Of Male Beneficiaries | 333 |
| Number Of Non Hispanic White Beneficiaries | 628 |
| Number Of Black or African American Beneficiaries | 90 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 40 |
| Number Of Beneficiaries With Medicare Only Entitlement | 397 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 375 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2784 |