| National Provider Identifier [NPI]: | 1003055401 |
| Last Name Of The Provider | PENRY |
| First Name Of The Provider | JACKSON |
| 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 | 27700 MEDICAL CENTER ROAD-RADIOLOGY DEPARTMENT |
| Street Address 2 Of The Provider | |
| City Of The Provider | MISSION VIEJO |
| Zip Code Of The Provider | 926916426 |
| 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 | 222 |
| Number Of Services | 6131 |
| Number Of Medicare Beneficiaries | 3471 |
| Total Submitted Charge Amount | 868714.5 |
| Total Medicare Allowed Amount | 268681.29 |
| Total Medicare Payment Amount | 203959.86 |
| Total Medicare Standardized Payment Amount | 193568.19 |
| 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 | 222 |
| Number Of Medical Services | 6131 |
| Number Of Medicare Beneficiaries With Medical Services | 3471 |
| Total Medical Submitted Charge Amount | 868714.5 |
| Total Medical Medicare Allowed Amount | 268681.29 |
| Total Medical Medicare Payment Amount | 203959.86 |
| Total Medical Medicare Standardized Payment Amount | 193568.19 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 224 |
| Number Of Beneficiaries Age 65 to 74 | 1308 |
| Number Of Beneficiaries Age 75 to 84 | 1150 |
| Number Of Beneficiaries Age Greater 84 | 789 |
| Number Of Female Beneficiaries | 2044 |
| Number Of Male Beneficiaries | 1427 |
| Number Of Non Hispanic White Beneficiaries | 3040 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 141 |
| Number Of Hispanic Beneficiaries | 187 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 64 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3078 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 393 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.5672 |