| National Provider Identifier [NPI]: | 1770538175 |
| Last Name Of The Provider | KONG |
| First Name Of The Provider | LIPU |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1001 TOWSON AVE |
| Street Address 2 Of The Provider | RADIOLOGY |
| City Of The Provider | FORT SMITH |
| Zip Code Of The Provider | 729014921 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 211 |
| Number Of Services | 7281 |
| Number Of Medicare Beneficiaries | 4300 |
| Total Submitted Charge Amount | 899342 |
| Total Medicare Allowed Amount | 221699.51 |
| Total Medicare Payment Amount | 170785.3 |
| Total Medicare Standardized Payment Amount | 180513.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 250 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 1750 |
| Total Drug Medicare AllowedAmount | 555.59 |
| Total Drug Medicare PaymentAmount | 409.63 |
| Total Drug Medicare Standardized Payment Amount | 409.63 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 210 |
| Number Of Medical Services | 7031 |
| Number Of Medicare Beneficiaries With Medical Services | 4300 |
| Total Medical Submitted Charge Amount | 897592 |
| Total Medical Medicare Allowed Amount | 221143.92 |
| Total Medical Medicare Payment Amount | 170375.67 |
| Total Medical Medicare Standardized Payment Amount | 180103.39 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 879 |
| Number Of Beneficiaries Age 65 to 74 | 1599 |
| Number Of Beneficiaries Age 75 to 84 | 1260 |
| Number Of Beneficiaries Age Greater 84 | 562 |
| Number Of Female Beneficiaries | 2788 |
| Number Of Male Beneficiaries | 1512 |
| Number Of Non Hispanic White Beneficiaries | 3263 |
| Number Of Black or African American Beneficiaries | 873 |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| Number Of Hispanic Beneficiaries | 47 |
| Number Of American Indian Alaska Native Beneficiaries | 81 |
| Number Of Beneficiaries With Race Not Else where Classified | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2827 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1473 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.7348 |