| National Provider Identifier [NPI]: | 1164698098 |
| Last Name Of The Provider | MA |
| First Name Of The Provider | JANET |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1245 16TH ST |
| Street Address 2 Of The Provider | SUITE 125 |
| City Of The Provider | SANTA MONICA |
| Zip Code Of The Provider | 904041235 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 52 |
| Number Of Services | 837 |
| Number Of Medicare Beneficiaries | 274 |
| Total Submitted Charge Amount | 137319.12 |
| Total Medicare Allowed Amount | 44817.05 |
| Total Medicare Payment Amount | 33245.32 |
| Total Medicare Standardized Payment Amount | 30777.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 19 |
| Number Of Drug Services | 287 |
| Number Of Medicare Beneficiaries With Drug Services | 51 |
| Total Drug Submitted ChargeAmount | 5441.23 |
| Total Drug Medicare AllowedAmount | 1226.06 |
| Total Drug Medicare PaymentAmount | 1128.94 |
| Total Drug Medicare Standardized Payment Amount | 1128.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 550 |
| Number Of Medicare Beneficiaries With Medical Services | 273 |
| Total Medical Submitted Charge Amount | 131877.89 |
| Total Medical Medicare Allowed Amount | 43590.99 |
| Total Medical Medicare Payment Amount | 32116.38 |
| Total Medical Medicare Standardized Payment Amount | 29649.04 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 44 |
| Number Of Beneficiaries Age 65 to 74 | 92 |
| Number Of Beneficiaries Age 75 to 84 | 68 |
| Number Of Beneficiaries Age Greater 84 | 70 |
| Number Of Female Beneficiaries | 186 |
| Number Of Male Beneficiaries | 88 |
| Number Of Non Hispanic White Beneficiaries | 161 |
| Number Of Black or African American Beneficiaries | 31 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 51 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 165 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 109 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 22 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.7335 |