| National Provider Identifier [NPI]: | 1053324970 |
| Last Name Of The Provider | BAN |
| First Name Of The Provider | SUSAN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 17400 IRVINE BLVD |
| Street Address 2 Of The Provider | SUITE F |
| City Of The Provider | TUSTIN |
| Zip Code Of The Provider | 927803030 |
| 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 | 57 |
| Number Of Services | 5777 |
| Number Of Medicare Beneficiaries | 407 |
| Total Submitted Charge Amount | 438918 |
| Total Medicare Allowed Amount | 234787.25 |
| Total Medicare Payment Amount | 188693.37 |
| Total Medicare Standardized Payment Amount | 172736.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 383 |
| Number Of Medicare Beneficiaries With Drug Services | 228 |
| Total Drug Submitted ChargeAmount | 27825 |
| Total Drug Medicare AllowedAmount | 13737.28 |
| Total Drug Medicare PaymentAmount | 13397.09 |
| Total Drug Medicare Standardized Payment Amount | 13397.09 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 50 |
| Number Of Medical Services | 5394 |
| Number Of Medicare Beneficiaries With Medical Services | 407 |
| Total Medical Submitted Charge Amount | 411093 |
| Total Medical Medicare Allowed Amount | 221049.97 |
| Total Medical Medicare Payment Amount | 175296.28 |
| Total Medical Medicare Standardized Payment Amount | 159339.39 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 159 |
| Number Of Beneficiaries Age 75 to 84 | 136 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 288 |
| Number Of Male Beneficiaries | 119 |
| Number Of Non Hispanic White Beneficiaries | 366 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 16 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9787 |