National Provider Identifier [NPI]: |
1871510370 |
Last Name Of The Provider |
LEE |
First Name Of The Provider |
SU |
Middle Initial Of The Provider |
K |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
1418 S SAN GABRIEL BLVD. , SUITE C |
Street Address 2 Of The Provider |
|
City Of The Provider |
SAN GABRIEL |
Zip Code Of The Provider |
91776 |
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 |
53 |
Number Of Services |
9074 |
Number Of Medicare Beneficiaries |
479 |
Total Submitted Charge Amount |
810635 |
Total Medicare Allowed Amount |
572627.37 |
Total Medicare Payment Amount |
422229.53 |
Total Medicare Standardized Payment Amount |
395092.89 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
14 |
Number Of Drug Services |
1259 |
Number Of Medicare Beneficiaries With Drug Services |
331 |
Total Drug Submitted ChargeAmount |
28245 |
Total Drug Medicare AllowedAmount |
6692.05 |
Total Drug Medicare PaymentAmount |
6106.69 |
Total Drug Medicare Standardized Payment Amount |
6106.69 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
39 |
Number Of Medical Services |
7815 |
Number Of Medicare Beneficiaries With Medical Services |
479 |
Total Medical Submitted Charge Amount |
782390 |
Total Medical Medicare Allowed Amount |
565935.32 |
Total Medical Medicare Payment Amount |
416122.84 |
Total Medical Medicare Standardized Payment Amount |
388986.2 |
Average Age Of Beneficiaries |
76 |
Number Of Beneficiaries Age Less65 |
21 |
Number Of Beneficiaries Age 65 to 74 |
189 |
Number Of Beneficiaries Age 75 to 84 |
184 |
Number Of Beneficiaries Age Greater 84 |
85 |
Number Of Female Beneficiaries |
282 |
Number Of Male Beneficiaries |
197 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
442 |
Number Of Hispanic Beneficiaries |
24 |
Number Of American Indian Alaska Native Beneficiaries |
0 |
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
15 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
464 |
Percent Of With Atrial Fibrillation |
7 |
Percent Of With Alzheimers Disease or Dementia |
39 |
Percent Of With Asthma |
6 |
Percent Of With Cancer |
9 |
Percent Of With Heart Failure |
22 |
Percent Of With Chronic Kidney Disease |
23 |
Percent Of With Chronic Obstructive Pulmonary Disease |
32 |
Percent Of With Depression |
18 |
Percent Of With Diabetes |
45 |
Percent Of With Hyperlipidemia |
75 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
75 |
Percent Of With Osteoporosis |
65 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
32 |
Percent Of With Schizophrenia Other PsychoticDisorders |
29 |
Percent Of With Stroke |
5 |
Average HCC Risk Score Of Beneficiaries |
1.6313 |