| National Provider Identifier [NPI]: | 1215189550 |
| Last Name Of The Provider | LEE |
| First Name Of The Provider | EDWARD |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5767 W CENTURY BLVD |
| Street Address 2 Of The Provider | STE 400 |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 900455631 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 129 |
| Number Of Services | 873 |
| Number Of Medicare Beneficiaries | 255 |
| Total Submitted Charge Amount | 2300204.83 |
| Total Medicare Allowed Amount | 127284.7 |
| Total Medicare Payment Amount | 99365.02 |
| Total Medicare Standardized Payment Amount | 94302.2 |
| 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 | 129 |
| Number Of Medical Services | 873 |
| Number Of Medicare Beneficiaries With Medical Services | 255 |
| Total Medical Submitted Charge Amount | 2300204.83 |
| Total Medical Medicare Allowed Amount | 127284.7 |
| Total Medical Medicare Payment Amount | 99365.02 |
| Total Medical Medicare Standardized Payment Amount | 94302.2 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 87 |
| Number Of Beneficiaries Age 65 to 74 | 85 |
| Number Of Beneficiaries Age 75 to 84 | 49 |
| Number Of Beneficiaries Age Greater 84 | 34 |
| Number Of Female Beneficiaries | 143 |
| Number Of Male Beneficiaries | 112 |
| Number Of Non Hispanic White Beneficiaries | 135 |
| Number Of Black or African American Beneficiaries | 33 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 55 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 130 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 125 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 24 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 70 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 4.167 |