National Provider Identifier [NPI]: |
1790776284 |
Last Name Of The Provider |
JIN |
First Name Of The Provider |
JONATHAN |
Middle Initial Of The Provider |
Y |
Credentials Of The Provider |
M.D. |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
11311 BRIDGEPORT WAY SW |
Street Address 2 Of The Provider |
204 |
City Of The Provider |
LAKEWOOD |
Zip Code Of The Provider |
984993071 |
State Code Of The Provider |
WA |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Internal Medicine |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
52 |
Number Of Services |
5186.5 |
Number Of Medicare Beneficiaries |
346 |
Total Submitted Charge Amount |
330369.5 |
Total Medicare Allowed Amount |
224927.48 |
Total Medicare Payment Amount |
159935.66 |
Total Medicare Standardized Payment Amount |
162178.67 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
8 |
Number Of Drug Services |
270.5 |
Number Of Medicare Beneficiaries With Drug Services |
214 |
Total Drug Submitted ChargeAmount |
6882 |
Total Drug Medicare AllowedAmount |
4081.45 |
Total Drug Medicare PaymentAmount |
3965.52 |
Total Drug Medicare Standardized Payment Amount |
3965.52 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
44 |
Number Of Medical Services |
4916 |
Number Of Medicare Beneficiaries With Medical Services |
346 |
Total Medical Submitted Charge Amount |
323487.5 |
Total Medical Medicare Allowed Amount |
220846.03 |
Total Medical Medicare Payment Amount |
155970.14 |
Total Medical Medicare Standardized Payment Amount |
158213.15 |
Average Age Of Beneficiaries |
76 |
Number Of Beneficiaries Age Less65 |
17 |
Number Of Beneficiaries Age 65 to 74 |
130 |
Number Of Beneficiaries Age 75 to 84 |
139 |
Number Of Beneficiaries Age Greater 84 |
60 |
Number Of Female Beneficiaries |
219 |
Number Of Male Beneficiaries |
127 |
Number Of Non Hispanic White Beneficiaries |
110 |
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
167 |
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
38 |
Number Of Beneficiaries With Medicare Only Entitlement |
216 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
130 |
Percent Of With Atrial Fibrillation |
6 |
Percent Of With Alzheimers Disease or Dementia |
12 |
Percent Of With Asthma |
7 |
Percent Of With Cancer |
11 |
Percent Of With Heart Failure |
14 |
Percent Of With Chronic Kidney Disease |
40 |
Percent Of With Chronic Obstructive Pulmonary Disease |
11 |
Percent Of With Depression |
43 |
Percent Of With Diabetes |
36 |
Percent Of With Hyperlipidemia |
75 |
Percent Of With Hypertension |
75 |
Percent Of With Ischemic Heart Disease |
26 |
Percent Of With Osteoporosis |
4 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
51 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.2238 |