National Provider Identifier [NPI]: |
1285799320 |
Last Name Of The Provider |
PAK |
First Name Of The Provider |
SEONAE |
Middle Initial Of The Provider |
|
Credentials Of The Provider |
MD |
Gender Of The Provider |
F |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
11445 SUNSET HILLS ROAD |
Street Address 2 Of The Provider |
|
City Of The Provider |
RESTON |
Zip Code Of The Provider |
201905276 |
State Code Of The Provider |
VA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
17 |
Number Of Services |
67 |
Number Of Medicare Beneficiaries |
18 |
Total Submitted Charge Amount |
7355.2 |
Total Medicare Allowed Amount |
4130.41 |
Total Medicare Payment Amount |
2733.87 |
Total Medicare Standardized Payment Amount |
2541.84 |
Drug Suppress Indicator |
* |
Number Of HCPCS Associated With Drug Services |
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Number Of Drug Services |
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Number Of Medicare Beneficiaries With Drug Services |
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Total Drug Submitted ChargeAmount |
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Total Drug Medicare AllowedAmount |
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Total Drug Medicare PaymentAmount |
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Total Drug Medicare Standardized Payment Amount |
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Medical SuppressIndicator |
# |
Number Of HCPCS Associated With MedicalServices |
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Number Of Medical Services |
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Number Of Medicare Beneficiaries With Medical Services |
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Total Medical Submitted Charge Amount |
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Total Medical Medicare Allowed Amount |
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Total Medical Medicare Payment Amount |
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Total Medical Medicare Standardized Payment Amount |
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Average Age Of Beneficiaries |
71 |
Number Of Beneficiaries Age Less65 |
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Number Of Beneficiaries Age 65 to 74 |
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Number Of Beneficiaries Age 75 to 84 |
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Number Of Beneficiaries Age Greater 84 |
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Number Of Female Beneficiaries |
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Number Of Male Beneficiaries |
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Number Of Non Hispanic White Beneficiaries |
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Number Of Black or African American Beneficiaries |
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Number Of AsianPacific Islander Beneficiaries |
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Number Of Hispanic Beneficiaries |
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Number Of American Indian Alaska Native Beneficiaries |
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Number Of Beneficiaries With Race Not Else where Classified |
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Number Of Beneficiaries With Medicare Only Entitlement |
18 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
0 |
Percent Of With Atrial Fibrillation |
0 |
Percent Of With Alzheimers Disease or Dementia |
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Percent Of With Asthma |
0 |
Percent Of With Cancer |
0 |
Percent Of With Heart Failure |
0 |
Percent Of With Chronic Kidney Disease |
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Percent Of With Chronic Obstructive Pulmonary Disease |
0 |
Percent Of With Depression |
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Percent Of With Diabetes |
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Percent Of With Hyperlipidemia |
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Percent Of With Hypertension |
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Percent Of With Ischemic Heart Disease |
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Percent Of With Osteoporosis |
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Percent Of With Rheumatoid Arthritis Osteoarthritis |
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Percent Of With Schizophrenia Other PsychoticDisorders |
0 |
Percent Of With Stroke |
0 |
Average HCC Risk Score Of Beneficiaries |
0.7767 |