| National Provider Identifier [NPI]: | 1407809858 |
| Last Name Of The Provider | LACY |
| First Name Of The Provider | GEORGE |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1520 SAN PABLO ST |
| Street Address 2 Of The Provider | LOWER LEVEL, STE 1600 |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 900335310 |
| 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 | 34 |
| Number Of Services | 940 |
| Number Of Medicare Beneficiaries | 544 |
| Total Submitted Charge Amount | 70036 |
| Total Medicare Allowed Amount | 18137.62 |
| Total Medicare Payment Amount | 13814.34 |
| Total Medicare Standardized Payment Amount | 13071.44 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 940 |
| Number Of Medicare Beneficiaries With Medical Services | 544 |
| Total Medical Submitted Charge Amount | 70036 |
| Total Medical Medicare Allowed Amount | 18137.62 |
| Total Medical Medicare Payment Amount | 13814.34 |
| Total Medical Medicare Standardized Payment Amount | 13071.44 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 145 |
| Number Of Beneficiaries Age 65 to 74 | 213 |
| Number Of Beneficiaries Age 75 to 84 | 148 |
| Number Of Beneficiaries Age Greater 84 | 38 |
| Number Of Female Beneficiaries | 273 |
| Number Of Male Beneficiaries | 271 |
| Number Of Non Hispanic White Beneficiaries | 270 |
| Number Of Black or African American Beneficiaries | 38 |
| Number Of AsianPacific Islander Beneficiaries | 70 |
| Number Of Hispanic Beneficiaries | 149 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 269 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 275 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 57 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.8073 |