| National Provider Identifier [NPI]: | 1104933761 |
| Last Name Of The Provider | LIM |
| First Name Of The Provider | BERNADETTE |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1505 WILSON TER |
| Street Address 2 Of The Provider | SUITE 250 |
| City Of The Provider | GLENDALE |
| Zip Code Of The Provider | 912064071 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 156 |
| Number Of Medicare Beneficiaries | 42 |
| Total Submitted Charge Amount | 7783 |
| Total Medicare Allowed Amount | 5122.32 |
| Total Medicare Payment Amount | 3374.23 |
| Total Medicare Standardized Payment Amount | 3061.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 39 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 279 |
| Total Drug Medicare AllowedAmount | 159.34 |
| Total Drug Medicare PaymentAmount | 123.79 |
| Total Drug Medicare Standardized Payment Amount | 123.79 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 117 |
| Number Of Medicare Beneficiaries With Medical Services | 42 |
| Total Medical Submitted Charge Amount | 7504 |
| Total Medical Medicare Allowed Amount | 4962.98 |
| Total Medical Medicare Payment Amount | 3250.44 |
| Total Medical Medicare Standardized Payment Amount | 2937.83 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 11 |
| Number Of Beneficiaries Age 75 to 84 | 11 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 23 |
| Number Of Male Beneficiaries | 19 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 25 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 11 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.546 |