| National Provider Identifier [NPI]: | 1578632485 |
| Last Name Of The Provider | LIE |
| First Name Of The Provider | KAM |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 17 MEDICAL PLAZA |
| Street Address 2 Of The Provider | |
| City Of The Provider | MOUNTAIN HOME |
| Zip Code Of The Provider | 72653 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 88 |
| Number Of Services | 7893 |
| Number Of Medicare Beneficiaries | 615 |
| Total Submitted Charge Amount | 526762 |
| Total Medicare Allowed Amount | 288749.71 |
| Total Medicare Payment Amount | 200487.2 |
| Total Medicare Standardized Payment Amount | 222001.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 27 |
| Number Of Drug Services | 2660 |
| Number Of Medicare Beneficiaries With Drug Services | 387 |
| Total Drug Submitted ChargeAmount | 33724 |
| Total Drug Medicare AllowedAmount | 12527.58 |
| Total Drug Medicare PaymentAmount | 10344.61 |
| Total Drug Medicare Standardized Payment Amount | 10344.61 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 61 |
| Number Of Medical Services | 5233 |
| Number Of Medicare Beneficiaries With Medical Services | 615 |
| Total Medical Submitted Charge Amount | 493038 |
| Total Medical Medicare Allowed Amount | 276222.13 |
| Total Medical Medicare Payment Amount | 190142.59 |
| Total Medical Medicare Standardized Payment Amount | 211657.02 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 250 |
| Number Of Beneficiaries Age 65 to 74 | 216 |
| Number Of Beneficiaries Age 75 to 84 | 111 |
| Number Of Beneficiaries Age Greater 84 | 38 |
| Number Of Female Beneficiaries | 354 |
| Number Of Male Beneficiaries | 261 |
| Number Of Non Hispanic White Beneficiaries | 599 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| 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 | 366 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 249 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 1.1532 |