| National Provider Identifier [NPI]: | 1689628083 |
| Last Name Of The Provider | HITTLE |
| First Name Of The Provider | THEODORE |
| 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 | 2202 WILSHIRE BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SANTA MONICA |
| Zip Code Of The Provider | 904035706 |
| 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 | 168 |
| Number Of Services | 8383 |
| Number Of Medicare Beneficiaries | 2653 |
| Total Submitted Charge Amount | 1062000.5 |
| Total Medicare Allowed Amount | 257285.61 |
| Total Medicare Payment Amount | 203272.08 |
| Total Medicare Standardized Payment Amount | 189298.46 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 2908 |
| Number Of Medicare Beneficiaries With Drug Services | 83 |
| Total Drug Submitted ChargeAmount | 6006.5 |
| Total Drug Medicare AllowedAmount | 1151.09 |
| Total Drug Medicare PaymentAmount | 899.55 |
| Total Drug Medicare Standardized Payment Amount | 899.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 165 |
| Number Of Medical Services | 5475 |
| Number Of Medicare Beneficiaries With Medical Services | 2653 |
| Total Medical Submitted Charge Amount | 1055994 |
| Total Medical Medicare Allowed Amount | 256134.52 |
| Total Medical Medicare Payment Amount | 202372.53 |
| Total Medical Medicare Standardized Payment Amount | 188398.91 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 371 |
| Number Of Beneficiaries Age 65 to 74 | 1150 |
| Number Of Beneficiaries Age 75 to 84 | 749 |
| Number Of Beneficiaries Age Greater 84 | 383 |
| Number Of Female Beneficiaries | 1929 |
| Number Of Male Beneficiaries | 724 |
| Number Of Non Hispanic White Beneficiaries | 2040 |
| Number Of Black or African American Beneficiaries | 90 |
| Number Of AsianPacific Islander Beneficiaries | 134 |
| Number Of Hispanic Beneficiaries | 328 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1978 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 675 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.5843 |