| National Provider Identifier [NPI]: | 1114975646 |
| Last Name Of The Provider | LI |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | Y |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 600 COFFEE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | MODESTO |
| Zip Code Of The Provider | 953554201 |
| 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 | 176 |
| Number Of Services | 22870 |
| Number Of Medicare Beneficiaries | 3603 |
| Total Submitted Charge Amount | 1729489.43 |
| Total Medicare Allowed Amount | 344762.98 |
| Total Medicare Payment Amount | 254981.57 |
| Total Medicare Standardized Payment Amount | 247105.01 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 17485 |
| Number Of Medicare Beneficiaries With Drug Services | 204 |
| Total Drug Submitted ChargeAmount | 20513.43 |
| Total Drug Medicare AllowedAmount | 4543.14 |
| Total Drug Medicare PaymentAmount | 3523.77 |
| Total Drug Medicare Standardized Payment Amount | 3523.77 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 171 |
| Number Of Medical Services | 5385 |
| Number Of Medicare Beneficiaries With Medical Services | 3603 |
| Total Medical Submitted Charge Amount | 1708976 |
| Total Medical Medicare Allowed Amount | 340219.84 |
| Total Medical Medicare Payment Amount | 251457.8 |
| Total Medical Medicare Standardized Payment Amount | 243581.24 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 783 |
| Number Of Beneficiaries Age 65 to 74 | 1374 |
| Number Of Beneficiaries Age 75 to 84 | 939 |
| Number Of Beneficiaries Age Greater 84 | 507 |
| Number Of Female Beneficiaries | 2184 |
| Number Of Male Beneficiaries | 1419 |
| Number Of Non Hispanic White Beneficiaries | 2560 |
| Number Of Black or African American Beneficiaries | 167 |
| Number Of AsianPacific Islander Beneficiaries | 162 |
| Number Of Hispanic Beneficiaries | 636 |
| Number Of American Indian Alaska Native Beneficiaries | 21 |
| Number Of Beneficiaries With Race Not Else where Classified | 57 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2234 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1369 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.6642 |