| National Provider Identifier [NPI]: | 1083664262 |
| Last Name Of The Provider | EVANGELISTA |
| First Name Of The Provider | BAYANI |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 39000 BOB HOPE DR |
| Street Address 2 Of The Provider | EISENHOWER IMAGING CENTER |
| City Of The Provider | RANCHO MIRAGE |
| Zip Code Of The Provider | 922703221 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 221 |
| Number Of Services | 61998 |
| Number Of Medicare Beneficiaries | 5788 |
| Total Submitted Charge Amount | 4771480.51 |
| Total Medicare Allowed Amount | 1443126.51 |
| Total Medicare Payment Amount | 1098822.56 |
| Total Medicare Standardized Payment Amount | 1073995.05 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 52150 |
| Number Of Medicare Beneficiaries With Drug Services | 721 |
| Total Drug Submitted ChargeAmount | 81227 |
| Total Drug Medicare AllowedAmount | 16704.33 |
| Total Drug Medicare PaymentAmount | 13053.51 |
| Total Drug Medicare Standardized Payment Amount | 13053.51 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 216 |
| Number Of Medical Services | 9848 |
| Number Of Medicare Beneficiaries With Medical Services | 5787 |
| Total Medical Submitted Charge Amount | 4690253.51 |
| Total Medical Medicare Allowed Amount | 1426422.18 |
| Total Medical Medicare Payment Amount | 1085769.05 |
| Total Medical Medicare Standardized Payment Amount | 1060941.54 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 390 |
| Number Of Beneficiaries Age 65 to 74 | 2027 |
| Number Of Beneficiaries Age 75 to 84 | 2164 |
| Number Of Beneficiaries Age Greater 84 | 1207 |
| Number Of Female Beneficiaries | 2994 |
| Number Of Male Beneficiaries | 2794 |
| Number Of Non Hispanic White Beneficiaries | 5109 |
| Number Of Black or African American Beneficiaries | 61 |
| Number Of AsianPacific Islander Beneficiaries | 53 |
| Number Of Hispanic Beneficiaries | 493 |
| Number Of American Indian Alaska Native Beneficiaries | 17 |
| Number Of Beneficiaries With Race Not Else where Classified | 55 |
| Number Of Beneficiaries With Medicare Only Entitlement | 5077 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 711 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.61 |