| National Provider Identifier [NPI]: | 1750332854 |
| Last Name Of The Provider | LESSIE |
| First Name Of The Provider | TODD |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 12112 RANCHO VISTOSO BLVD 150-221 |
| Street Address 2 Of The Provider | |
| City Of The Provider | TUCSON |
| Zip Code Of The Provider | 85755 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 169 |
| Number Of Services | 5889 |
| Number Of Medicare Beneficiaries | 2119 |
| Total Submitted Charge Amount | 509486 |
| Total Medicare Allowed Amount | 160552.64 |
| Total Medicare Payment Amount | 121857.99 |
| Total Medicare Standardized Payment Amount | 123858.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 2500 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 7500 |
| Total Drug Medicare AllowedAmount | 493.32 |
| Total Drug Medicare PaymentAmount | 386.71 |
| Total Drug Medicare Standardized Payment Amount | 386.71 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 168 |
| Number Of Medical Services | 3389 |
| Number Of Medicare Beneficiaries With Medical Services | 2119 |
| Total Medical Submitted Charge Amount | 501986 |
| Total Medical Medicare Allowed Amount | 160059.32 |
| Total Medical Medicare Payment Amount | 121471.28 |
| Total Medical Medicare Standardized Payment Amount | 123471.51 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 292 |
| Number Of Beneficiaries Age 65 to 74 | 829 |
| Number Of Beneficiaries Age 75 to 84 | 658 |
| Number Of Beneficiaries Age Greater 84 | 340 |
| Number Of Female Beneficiaries | 1142 |
| Number Of Male Beneficiaries | 977 |
| Number Of Non Hispanic White Beneficiaries | 1506 |
| Number Of Black or African American Beneficiaries | 53 |
| Number Of AsianPacific Islander Beneficiaries | 13 |
| Number Of Hispanic Beneficiaries | 432 |
| Number Of American Indian Alaska Native Beneficiaries | 91 |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1606 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 513 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6751 |