| National Provider Identifier [NPI]: | 1972589687 |
| Last Name Of The Provider | SONG |
| First Name Of The Provider | CHAEWON |
| 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 | 12665 GARDEN GROVE BLVD |
| Street Address 2 Of The Provider | SUITE 503 |
| City Of The Provider | GARDEN GROVE |
| Zip Code Of The Provider | 928431901 |
| 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 | 64 |
| Number Of Services | 11880 |
| Number Of Medicare Beneficiaries | 981 |
| Total Submitted Charge Amount | 919885 |
| Total Medicare Allowed Amount | 743238.69 |
| Total Medicare Payment Amount | 577495.33 |
| Total Medicare Standardized Payment Amount | 551643.09 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 15 |
| Number Of Drug Services | 789 |
| Number Of Medicare Beneficiaries With Drug Services | 386 |
| Total Drug Submitted ChargeAmount | 16220 |
| Total Drug Medicare AllowedAmount | 8661.62 |
| Total Drug Medicare PaymentAmount | 8437.72 |
| Total Drug Medicare Standardized Payment Amount | 8437.72 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 49 |
| Number Of Medical Services | 11091 |
| Number Of Medicare Beneficiaries With Medical Services | 981 |
| Total Medical Submitted Charge Amount | 903665 |
| Total Medical Medicare Allowed Amount | 734577.07 |
| Total Medical Medicare Payment Amount | 569057.61 |
| Total Medical Medicare Standardized Payment Amount | 543205.37 |
| Average Age Of Beneficiaries | 82 |
| Number Of Beneficiaries Age Less65 | 14 |
| Number Of Beneficiaries Age 65 to 74 | 202 |
| Number Of Beneficiaries Age 75 to 84 | 363 |
| Number Of Beneficiaries Age Greater 84 | 402 |
| Number Of Female Beneficiaries | 686 |
| Number Of Male Beneficiaries | 295 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 914 |
| Number Of Hispanic Beneficiaries | 18 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 35 |
| Number Of Beneficiaries With Medicare Only Entitlement | 72 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 909 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 47 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 56 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 46 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.0238 |