| National Provider Identifier [NPI]: | 1497737639 |
| Last Name Of The Provider | DALSASO |
| First Name Of The Provider | TIMOTHY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2700 DOLBEER ST |
| Street Address 2 Of The Provider | ST. JOSEPH HOSPITAL |
| City Of The Provider | EUREKA |
| Zip Code Of The Provider | 955014736 |
| 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 | 247 |
| Number Of Services | 6302 |
| Number Of Medicare Beneficiaries | 3159 |
| Total Submitted Charge Amount | 679158 |
| Total Medicare Allowed Amount | 256524.59 |
| Total Medicare Payment Amount | 186315.13 |
| Total Medicare Standardized Payment Amount | 184217.43 |
| 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 | 247 |
| Number Of Medical Services | 6302 |
| Number Of Medicare Beneficiaries With Medical Services | 3159 |
| Total Medical Submitted Charge Amount | 679158 |
| Total Medical Medicare Allowed Amount | 256524.59 |
| Total Medical Medicare Payment Amount | 186315.13 |
| Total Medical Medicare Standardized Payment Amount | 184217.43 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 665 |
| Number Of Beneficiaries Age 65 to 74 | 1218 |
| Number Of Beneficiaries Age 75 to 84 | 837 |
| Number Of Beneficiaries Age Greater 84 | 439 |
| Number Of Female Beneficiaries | 1735 |
| Number Of Male Beneficiaries | 1424 |
| Number Of Non Hispanic White Beneficiaries | 2811 |
| Number Of Black or African American Beneficiaries | 30 |
| Number Of AsianPacific Islander Beneficiaries | 36 |
| Number Of Hispanic Beneficiaries | 93 |
| Number Of American Indian Alaska Native Beneficiaries | 150 |
| Number Of Beneficiaries With Race Not Else where Classified | 39 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2175 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 984 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4709 |