| National Provider Identifier [NPI]: | 1730402561 |
| Last Name Of The Provider | BELEN |
| First Name Of The Provider | KRISTIN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3031 TISCH WAY |
| Street Address 2 Of The Provider | SUITE #400 |
| City Of The Provider | SAN JOSE |
| Zip Code Of The Provider | 951282541 |
| 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 | 99 |
| Number Of Services | 5323 |
| Number Of Medicare Beneficiaries | 1658 |
| Total Submitted Charge Amount | 790277 |
| Total Medicare Allowed Amount | 293429.71 |
| Total Medicare Payment Amount | 249697.16 |
| Total Medicare Standardized Payment Amount | 195816.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 2449 |
| Number Of Medicare Beneficiaries With Drug Services | 35 |
| Total Drug Submitted ChargeAmount | 3113 |
| Total Drug Medicare AllowedAmount | 716.97 |
| Total Drug Medicare PaymentAmount | 541.2 |
| Total Drug Medicare Standardized Payment Amount | 541.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 97 |
| Number Of Medical Services | 2874 |
| Number Of Medicare Beneficiaries With Medical Services | 1658 |
| Total Medical Submitted Charge Amount | 787164 |
| Total Medical Medicare Allowed Amount | 292712.74 |
| Total Medical Medicare Payment Amount | 249155.96 |
| Total Medical Medicare Standardized Payment Amount | 195275.02 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 126 |
| Number Of Beneficiaries Age 65 to 74 | 871 |
| Number Of Beneficiaries Age 75 to 84 | 524 |
| Number Of Beneficiaries Age Greater 84 | 137 |
| Number Of Female Beneficiaries | 1326 |
| Number Of Male Beneficiaries | 332 |
| Number Of Non Hispanic White Beneficiaries | 776 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 646 |
| Number Of Hispanic Beneficiaries | 155 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 51 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1008 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 650 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 12 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 19 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.983 |