| National Provider Identifier [NPI]: | 1225055866 |
| Last Name Of The Provider | KIM |
| First Name Of The Provider | JAE |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10400 SOUTHWEST HWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHICAGO RIDGE |
| Zip Code Of The Provider | 604151367 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 112 |
| Number Of Services | 10503 |
| Number Of Medicare Beneficiaries | 1051 |
| Total Submitted Charge Amount | 2027629 |
| Total Medicare Allowed Amount | 553889.62 |
| Total Medicare Payment Amount | 416630.63 |
| Total Medicare Standardized Payment Amount | 394781.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 4134 |
| Number Of Medicare Beneficiaries With Drug Services | 65 |
| Total Drug Submitted ChargeAmount | 244807 |
| Total Drug Medicare AllowedAmount | 69994.38 |
| Total Drug Medicare PaymentAmount | 54744.65 |
| Total Drug Medicare Standardized Payment Amount | 54744.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 106 |
| Number Of Medical Services | 6369 |
| Number Of Medicare Beneficiaries With Medical Services | 1051 |
| Total Medical Submitted Charge Amount | 1782822 |
| Total Medical Medicare Allowed Amount | 483895.24 |
| Total Medical Medicare Payment Amount | 361885.98 |
| Total Medical Medicare Standardized Payment Amount | 340037.18 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 84 |
| Number Of Beneficiaries Age 65 to 74 | 459 |
| Number Of Beneficiaries Age 75 to 84 | 348 |
| Number Of Beneficiaries Age Greater 84 | 160 |
| Number Of Female Beneficiaries | 492 |
| Number Of Male Beneficiaries | 559 |
| Number Of Non Hispanic White Beneficiaries | 796 |
| Number Of Black or African American Beneficiaries | 170 |
| Number Of AsianPacific Islander Beneficiaries | 15 |
| Number Of Hispanic Beneficiaries | 54 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 929 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 122 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.363 |