| National Provider Identifier [NPI]: | 1174655914 |
| Last Name Of The Provider | KIM |
| First Name Of The Provider | PETER |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 133 BROOKLINE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | BOSTON |
| Zip Code Of The Provider | 022153904 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Plastic and Reconstructive Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 95 |
| Number Of Services | 652 |
| Number Of Medicare Beneficiaries | 230 |
| Total Submitted Charge Amount | 263159.75 |
| Total Medicare Allowed Amount | 120174.97 |
| Total Medicare Payment Amount | 92370.22 |
| Total Medicare Standardized Payment Amount | 84656.04 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 90 |
| Number Of Medicare Beneficiaries With Drug Services | 66 |
| Total Drug Submitted ChargeAmount | 370 |
| Total Drug Medicare AllowedAmount | 160.32 |
| Total Drug Medicare PaymentAmount | 123.96 |
| Total Drug Medicare Standardized Payment Amount | 123.96 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 94 |
| Number Of Medical Services | 562 |
| Number Of Medicare Beneficiaries With Medical Services | 230 |
| Total Medical Submitted Charge Amount | 262789.75 |
| Total Medical Medicare Allowed Amount | 120014.65 |
| Total Medical Medicare Payment Amount | 92246.26 |
| Total Medical Medicare Standardized Payment Amount | 84532.08 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 39 |
| Number Of Beneficiaries Age 65 to 74 | 125 |
| Number Of Beneficiaries Age 75 to 84 | 54 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 141 |
| Number Of Male Beneficiaries | 89 |
| Number Of Non Hispanic White Beneficiaries | 185 |
| Number Of Black or African American Beneficiaries | 22 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 177 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 53 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1369 |