| National Provider Identifier [NPI]: | 1720016140 |
| Last Name Of The Provider | LIEN |
| First Name Of The Provider | JONATHAN |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 877 OAK PARK BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | PISMO BEACH |
| Zip Code Of The Provider | 934493292 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 1531 |
| Number Of Medicare Beneficiaries | 502 |
| Total Submitted Charge Amount | 168623 |
| Total Medicare Allowed Amount | 150053.98 |
| Total Medicare Payment Amount | 96739.41 |
| Total Medicare Standardized Payment Amount | 93108.57 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 94 |
| Number Of Medicare Beneficiaries With Drug Services | 78 |
| Total Drug Submitted ChargeAmount | 2569 |
| Total Drug Medicare AllowedAmount | 2323.46 |
| Total Drug Medicare PaymentAmount | 2268.94 |
| Total Drug Medicare Standardized Payment Amount | 2268.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 18 |
| Number Of Medical Services | 1437 |
| Number Of Medicare Beneficiaries With Medical Services | 502 |
| Total Medical Submitted Charge Amount | 166054 |
| Total Medical Medicare Allowed Amount | 147730.52 |
| Total Medical Medicare Payment Amount | 94470.47 |
| Total Medical Medicare Standardized Payment Amount | 90839.63 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 20 |
| Number Of Beneficiaries Age 65 to 74 | 236 |
| Number Of Beneficiaries Age 75 to 84 | 157 |
| Number Of Beneficiaries Age Greater 84 | 89 |
| Number Of Female Beneficiaries | 242 |
| Number Of Male Beneficiaries | 260 |
| Number Of Non Hispanic White Beneficiaries | 455 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 29 |
| 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 | 9 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 19 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 26 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.8552 |