| National Provider Identifier [NPI]: | 1417918764 |
| Last Name Of The Provider | LIZAMA |
| First Name Of The Provider | VINCENT |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 548 SOUTH MARINE CORPS DRIVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | TAMUNING |
| Zip Code Of The Provider | 96913 |
| State Code Of The Provider | GU |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 143 |
| Number Of Services | 10315 |
| Number Of Medicare Beneficiaries | 1337 |
| Total Submitted Charge Amount | 213198.32 |
| Total Medicare Allowed Amount | 165721.13 |
| Total Medicare Payment Amount | 118192.86 |
| Total Medicare Standardized Payment Amount | 108886.25 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 7701 |
| Number Of Medicare Beneficiaries With Drug Services | 75 |
| Total Drug Submitted ChargeAmount | 1730 |
| Total Drug Medicare AllowedAmount | 1552.6 |
| Total Drug Medicare PaymentAmount | 1124.07 |
| Total Drug Medicare Standardized Payment Amount | 1124.07 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 140 |
| Number Of Medical Services | 2614 |
| Number Of Medicare Beneficiaries With Medical Services | 1337 |
| Total Medical Submitted Charge Amount | 211468.32 |
| Total Medical Medicare Allowed Amount | 164168.53 |
| Total Medical Medicare Payment Amount | 117068.79 |
| Total Medical Medicare Standardized Payment Amount | 107762.18 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 182 |
| Number Of Beneficiaries Age 65 to 74 | 589 |
| Number Of Beneficiaries Age 75 to 84 | 444 |
| Number Of Beneficiaries Age Greater 84 | 122 |
| Number Of Female Beneficiaries | 836 |
| Number Of Male Beneficiaries | 501 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 687 |
| Number Of Hispanic Beneficiaries | 385 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 179 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1317 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 20 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 3 |
| Percent Of With Diabetes | 56 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 16 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4838 |