| National Provider Identifier [NPI]: | 1083641518 |
| Last Name Of The Provider | NISHIMOTO |
| First Name Of The Provider | WADE |
| Middle Initial Of The Provider | Y |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6801 PARK TERRACE |
| Street Address 2 Of The Provider | 130 |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 900454025 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 64 |
| Number Of Services | 91575 |
| Number Of Medicare Beneficiaries | 538 |
| Total Submitted Charge Amount | 1998168.89 |
| Total Medicare Allowed Amount | 1542794.96 |
| Total Medicare Payment Amount | 1197057.52 |
| Total Medicare Standardized Payment Amount | 1170413.71 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 39 |
| Number Of Drug Services | 88083 |
| Number Of Medicare Beneficiaries With Drug Services | 101 |
| Total Drug Submitted ChargeAmount | 1571106.17 |
| Total Drug Medicare AllowedAmount | 1205489.93 |
| Total Drug Medicare PaymentAmount | 943616.81 |
| Total Drug Medicare Standardized Payment Amount | 943616.81 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 25 |
| Number Of Medical Services | 3492 |
| Number Of Medicare Beneficiaries With Medical Services | 538 |
| Total Medical Submitted Charge Amount | 427062.72 |
| Total Medical Medicare Allowed Amount | 337305.03 |
| Total Medical Medicare Payment Amount | 253440.71 |
| Total Medical Medicare Standardized Payment Amount | 226796.9 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 27 |
| Number Of Beneficiaries Age 65 to 74 | 207 |
| Number Of Beneficiaries Age 75 to 84 | 206 |
| Number Of Beneficiaries Age Greater 84 | 98 |
| Number Of Female Beneficiaries | 342 |
| Number Of Male Beneficiaries | 196 |
| Number Of Non Hispanic White Beneficiaries | 311 |
| Number Of Black or African American Beneficiaries | 30 |
| Number Of AsianPacific Islander Beneficiaries | 131 |
| Number Of Hispanic Beneficiaries | 44 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 447 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 91 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 48 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.5662 |