| National Provider Identifier [NPI]: | 1073578704 |
| Last Name Of The Provider | KIM |
| First Name Of The Provider | CASEY |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 18623 HIGHWAY 99 |
| Street Address 2 Of The Provider | STE 230 |
| City Of The Provider | LYNNWOOD |
| Zip Code Of The Provider | 980374552 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 306 |
| Number Of Medicare Beneficiaries | 66 |
| Total Submitted Charge Amount | 42178 |
| Total Medicare Allowed Amount | 21597 |
| Total Medicare Payment Amount | 13968.25 |
| Total Medicare Standardized Payment Amount | 14045.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 26 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 1205 |
| Total Drug Medicare AllowedAmount | 784.92 |
| Total Drug Medicare PaymentAmount | 766.88 |
| Total Drug Medicare Standardized Payment Amount | 766.88 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 280 |
| Number Of Medicare Beneficiaries With Medical Services | 66 |
| Total Medical Submitted Charge Amount | 40973 |
| Total Medical Medicare Allowed Amount | 20812.08 |
| Total Medical Medicare Payment Amount | 13201.37 |
| Total Medical Medicare Standardized Payment Amount | 13278.85 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | 30 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 38 |
| Number Of Male Beneficiaries | 28 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 0 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | 0 |
| Percent Of With Depression | |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 55 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 0 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8646 |