| National Provider Identifier [NPI]: | 1184600918 |
| Last Name Of The Provider | SANDOVAL |
| First Name Of The Provider | KENNETH |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8401 DATAPOINT DR STE 600 |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAN ANTONIO |
| Zip Code Of The Provider | 782295907 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 207 |
| Number Of Services | 33426 |
| Number Of Medicare Beneficiaries | 8083 |
| Total Submitted Charge Amount | 2436022 |
| Total Medicare Allowed Amount | 776664.09 |
| Total Medicare Payment Amount | 645084.69 |
| Total Medicare Standardized Payment Amount | 698303.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 20171 |
| Number Of Medicare Beneficiaries With Drug Services | 239 |
| Total Drug Submitted ChargeAmount | 14323 |
| Total Drug Medicare AllowedAmount | 6218.92 |
| Total Drug Medicare PaymentAmount | 4832.75 |
| Total Drug Medicare Standardized Payment Amount | 4832.75 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 204 |
| Number Of Medical Services | 13255 |
| Number Of Medicare Beneficiaries With Medical Services | 8083 |
| Total Medical Submitted Charge Amount | 2421699 |
| Total Medical Medicare Allowed Amount | 770445.17 |
| Total Medical Medicare Payment Amount | 640251.94 |
| Total Medical Medicare Standardized Payment Amount | 693470.93 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 1076 |
| Number Of Beneficiaries Age 65 to 74 | 3713 |
| Number Of Beneficiaries Age 75 to 84 | 2291 |
| Number Of Beneficiaries Age Greater 84 | 1003 |
| Number Of Female Beneficiaries | 5592 |
| Number Of Male Beneficiaries | 2491 |
| Number Of Non Hispanic White Beneficiaries | 5546 |
| Number Of Black or African American Beneficiaries | 410 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 1937 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 94 |
| Number Of Beneficiaries With Medicare Only Entitlement | 6757 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1326 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.5228 |