| National Provider Identifier [NPI]: | 1710181854 |
| Last Name Of The Provider | PARK |
| First Name Of The Provider | SAMUEL |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 26730 CROWN VALLEY PKWY |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | MISSION VIEJO |
| Zip Code Of The Provider | 926916364 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 100 |
| Number Of Services | 4038 |
| Number Of Medicare Beneficiaries | 293 |
| Total Submitted Charge Amount | 634060 |
| Total Medicare Allowed Amount | 281285.6 |
| Total Medicare Payment Amount | 217655.53 |
| Total Medicare Standardized Payment Amount | 179043.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 269 |
| Number Of Medicare Beneficiaries With Drug Services | 72 |
| Total Drug Submitted ChargeAmount | 28766 |
| Total Drug Medicare AllowedAmount | 10578.44 |
| Total Drug Medicare PaymentAmount | 8293.58 |
| Total Drug Medicare Standardized Payment Amount | 8293.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 97 |
| Number Of Medical Services | 3769 |
| Number Of Medicare Beneficiaries With Medical Services | 293 |
| Total Medical Submitted Charge Amount | 605294 |
| Total Medical Medicare Allowed Amount | 270707.16 |
| Total Medical Medicare Payment Amount | 209361.95 |
| Total Medical Medicare Standardized Payment Amount | 170749.45 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 14 |
| Number Of Beneficiaries Age 65 to 74 | 135 |
| Number Of Beneficiaries Age 75 to 84 | 93 |
| Number Of Beneficiaries Age Greater 84 | 51 |
| Number Of Female Beneficiaries | 187 |
| Number Of Male Beneficiaries | 106 |
| Number Of Non Hispanic White Beneficiaries | 267 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 11 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 275 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 18 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.2454 |