| National Provider Identifier [NPI]: | 1235330754 |
| Last Name Of The Provider | HARTZ |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1304 FAWCETT AVE |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | TACOMA |
| Zip Code Of The Provider | 984021911 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 116 |
| Number Of Services | 6037 |
| Number Of Medicare Beneficiaries | 2332 |
| Total Submitted Charge Amount | 843925.46 |
| Total Medicare Allowed Amount | 209191.65 |
| Total Medicare Payment Amount | 155263.7 |
| Total Medicare Standardized Payment Amount | 159955.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 2903 |
| Number Of Medicare Beneficiaries With Drug Services | 79 |
| Total Drug Submitted ChargeAmount | 10840.5 |
| Total Drug Medicare AllowedAmount | 2140.43 |
| Total Drug Medicare PaymentAmount | 1608.91 |
| Total Drug Medicare Standardized Payment Amount | 1608.91 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 113 |
| Number Of Medical Services | 3134 |
| Number Of Medicare Beneficiaries With Medical Services | 2331 |
| Total Medical Submitted Charge Amount | 833084.96 |
| Total Medical Medicare Allowed Amount | 207051.22 |
| Total Medical Medicare Payment Amount | 153654.79 |
| Total Medical Medicare Standardized Payment Amount | 158346.57 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 454 |
| Number Of Beneficiaries Age 65 to 74 | 843 |
| Number Of Beneficiaries Age 75 to 84 | 669 |
| Number Of Beneficiaries Age Greater 84 | 366 |
| Number Of Female Beneficiaries | 1316 |
| Number Of Male Beneficiaries | 1016 |
| Number Of Non Hispanic White Beneficiaries | 1863 |
| Number Of Black or African American Beneficiaries | 185 |
| Number Of AsianPacific Islander Beneficiaries | 133 |
| Number Of Hispanic Beneficiaries | 71 |
| Number Of American Indian Alaska Native Beneficiaries | 35 |
| Number Of Beneficiaries With Race Not Else where Classified | 45 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1636 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 696 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 20 |
| Average HCC Risk Score Of Beneficiaries | 1.691 |