| National Provider Identifier [NPI]: | 1023059763 |
| Last Name Of The Provider | FORMAN |
| First Name Of The Provider | STEVEN |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3771 KATELLA AVE |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | LOS ALAMITOS |
| Zip Code Of The Provider | 907203108 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 96 |
| Number Of Services | 2901 |
| Number Of Medicare Beneficiaries | 954 |
| Total Submitted Charge Amount | 861302.12 |
| Total Medicare Allowed Amount | 383076.22 |
| Total Medicare Payment Amount | 290217.09 |
| Total Medicare Standardized Payment Amount | 263590.64 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 36 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 3040 |
| Total Drug Medicare AllowedAmount | 675.4 |
| Total Drug Medicare PaymentAmount | 462.47 |
| Total Drug Medicare Standardized Payment Amount | 462.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 92 |
| Number Of Medical Services | 2865 |
| Number Of Medicare Beneficiaries With Medical Services | 954 |
| Total Medical Submitted Charge Amount | 858262.12 |
| Total Medical Medicare Allowed Amount | 382400.82 |
| Total Medical Medicare Payment Amount | 289754.62 |
| Total Medical Medicare Standardized Payment Amount | 263128.17 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 287 |
| Number Of Beneficiaries Age 75 to 84 | 352 |
| Number Of Beneficiaries Age Greater 84 | 269 |
| Number Of Female Beneficiaries | 513 |
| Number Of Male Beneficiaries | 441 |
| Number Of Non Hispanic White Beneficiaries | 738 |
| Number Of Black or African American Beneficiaries | 31 |
| Number Of AsianPacific Islander Beneficiaries | 84 |
| Number Of Hispanic Beneficiaries | 89 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 807 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 147 |
| Percent Of With Atrial Fibrillation | 28 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.6417 |