| National Provider Identifier [NPI]: | 1942208335 |
| Last Name Of The Provider | CHI |
| First Name Of The Provider | WAN |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1125 SIR FRANCIS DRAKE BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | KENTFIELD |
| Zip Code Of The Provider | 949041418 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physical Medicine and Rehabilitation |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 5 |
| Number Of Services | 1360 |
| Number Of Medicare Beneficiaries | 192 |
| Total Submitted Charge Amount | 156115 |
| Total Medicare Allowed Amount | 127100.74 |
| Total Medicare Payment Amount | 99606.51 |
| Total Medicare Standardized Payment Amount | 89050.84 |
| 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 | 5 |
| Number Of Medical Services | 1360 |
| Number Of Medicare Beneficiaries With Medical Services | 192 |
| Total Medical Submitted Charge Amount | 156115 |
| Total Medical Medicare Allowed Amount | 127100.74 |
| Total Medical Medicare Payment Amount | 99606.51 |
| Total Medical Medicare Standardized Payment Amount | 89050.84 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 32 |
| Number Of Beneficiaries Age 65 to 74 | 72 |
| Number Of Beneficiaries Age 75 to 84 | 58 |
| Number Of Beneficiaries Age Greater 84 | 30 |
| Number Of Female Beneficiaries | 116 |
| Number Of Male Beneficiaries | 76 |
| Number Of Non Hispanic White Beneficiaries | 122 |
| Number Of Black or African American Beneficiaries | 18 |
| Number Of AsianPacific Islander Beneficiaries | 35 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 121 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 71 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 27 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 64 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 30 |
| Average HCC Risk Score Of Beneficiaries | 1.3596 |