| National Provider Identifier [NPI]: | 1558576686 |
| Last Name Of The Provider | HO |
| First Name Of The Provider | LIAWATY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2851 N TENAYA WAY |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | LAS VEGAS |
| Zip Code Of The Provider | 89128 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 113 |
| Number Of Services | 62367 |
| Number Of Medicare Beneficiaries | 242 |
| Total Submitted Charge Amount | 1749569.07 |
| Total Medicare Allowed Amount | 742186.1 |
| Total Medicare Payment Amount | 584610.47 |
| Total Medicare Standardized Payment Amount | 577405.31 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 51 |
| Number Of Drug Services | 57639 |
| Number Of Medicare Beneficiaries With Drug Services | 98 |
| Total Drug Submitted ChargeAmount | 1184926.07 |
| Total Drug Medicare AllowedAmount | 505218.93 |
| Total Drug Medicare PaymentAmount | 395572 |
| Total Drug Medicare Standardized Payment Amount | 395572 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 62 |
| Number Of Medical Services | 4728 |
| Number Of Medicare Beneficiaries With Medical Services | 242 |
| Total Medical Submitted Charge Amount | 564643 |
| Total Medical Medicare Allowed Amount | 236967.17 |
| Total Medical Medicare Payment Amount | 189038.47 |
| Total Medical Medicare Standardized Payment Amount | 181833.31 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 121 |
| Number Of Beneficiaries Age 75 to 84 | 67 |
| Number Of Beneficiaries Age Greater 84 | 29 |
| Number Of Female Beneficiaries | 161 |
| Number Of Male Beneficiaries | 81 |
| Number Of Non Hispanic White Beneficiaries | 178 |
| Number Of Black or African American Beneficiaries | 28 |
| Number Of AsianPacific Islander Beneficiaries | 18 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 219 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 23 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 43 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.8896 |