| National Provider Identifier [NPI]: | 1528044922 |
| Last Name Of The Provider | LEVITAN |
| First Name Of The Provider | JAN |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 67-1125 MAMALAHOA HWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | KAMUELA |
| Zip Code Of The Provider | 967438496 |
| State Code Of The Provider | HI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 120 |
| Number Of Services | 2246 |
| Number Of Medicare Beneficiaries | 1506 |
| Total Submitted Charge Amount | 576885 |
| Total Medicare Allowed Amount | 82976.75 |
| Total Medicare Payment Amount | 63553.54 |
| Total Medicare Standardized Payment Amount | 63039.23 |
| 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 | 120 |
| Number Of Medical Services | 2246 |
| Number Of Medicare Beneficiaries With Medical Services | 1506 |
| Total Medical Submitted Charge Amount | 576885 |
| Total Medical Medicare Allowed Amount | 82976.75 |
| Total Medical Medicare Payment Amount | 63553.54 |
| Total Medical Medicare Standardized Payment Amount | 63039.23 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 260 |
| Number Of Beneficiaries Age 65 to 74 | 542 |
| Number Of Beneficiaries Age 75 to 84 | 428 |
| Number Of Beneficiaries Age Greater 84 | 276 |
| Number Of Female Beneficiaries | 916 |
| Number Of Male Beneficiaries | 590 |
| Number Of Non Hispanic White Beneficiaries | 1014 |
| Number Of Black or African American Beneficiaries | 204 |
| Number Of AsianPacific Islander Beneficiaries | 140 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 77 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1089 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 417 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.8599 |