| National Provider Identifier [NPI]: | 1871702316 |
| Last Name Of The Provider | CODORNIZ |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11234 ANDERSON ST |
| Street Address 2 Of The Provider | LLUMC HOUSE STAFF OFFICE CP 21005 |
| City Of The Provider | LOMA LINDA |
| Zip Code Of The Provider | 923542804 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Endocrinology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 1129 |
| Number Of Medicare Beneficiaries | 386 |
| Total Submitted Charge Amount | 263464 |
| Total Medicare Allowed Amount | 92002.16 |
| Total Medicare Payment Amount | 68595.83 |
| Total Medicare Standardized Payment Amount | 66862.43 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 44 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 2656 |
| Total Drug Medicare AllowedAmount | 777.53 |
| Total Drug Medicare PaymentAmount | 655.96 |
| Total Drug Medicare Standardized Payment Amount | 655.96 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 18 |
| Number Of Medical Services | 1085 |
| Number Of Medicare Beneficiaries With Medical Services | 386 |
| Total Medical Submitted Charge Amount | 260808 |
| Total Medical Medicare Allowed Amount | 91224.63 |
| Total Medical Medicare Payment Amount | 67939.87 |
| Total Medical Medicare Standardized Payment Amount | 66206.47 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 132 |
| Number Of Beneficiaries Age 65 to 74 | 153 |
| Number Of Beneficiaries Age 75 to 84 | 80 |
| Number Of Beneficiaries Age Greater 84 | 21 |
| Number Of Female Beneficiaries | 223 |
| Number Of Male Beneficiaries | 163 |
| Number Of Non Hispanic White Beneficiaries | 193 |
| Number Of Black or African American Beneficiaries | 52 |
| Number Of AsianPacific Islander Beneficiaries | 23 |
| Number Of Hispanic Beneficiaries | 107 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 194 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 192 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 75 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.4459 |