| National Provider Identifier [NPI]: | 1821012519 |
| Last Name Of The Provider | PACHECO |
| First Name Of The Provider | JOSE |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3680 BROADWAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT MYERS |
| Zip Code Of The Provider | 339018005 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 155 |
| Number Of Services | 30827 |
| Number Of Medicare Beneficiaries | 4224 |
| Total Submitted Charge Amount | 1883340.92 |
| Total Medicare Allowed Amount | 587848.63 |
| Total Medicare Payment Amount | 447068.92 |
| Total Medicare Standardized Payment Amount | 431844.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 24881 |
| Number Of Medicare Beneficiaries With Drug Services | 285 |
| Total Drug Submitted ChargeAmount | 31649.14 |
| Total Drug Medicare AllowedAmount | 5186.24 |
| Total Drug Medicare PaymentAmount | 4007.85 |
| Total Drug Medicare Standardized Payment Amount | 4007.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 151 |
| Number Of Medical Services | 5946 |
| Number Of Medicare Beneficiaries With Medical Services | 4224 |
| Total Medical Submitted Charge Amount | 1851691.78 |
| Total Medical Medicare Allowed Amount | 582662.39 |
| Total Medical Medicare Payment Amount | 443061.07 |
| Total Medical Medicare Standardized Payment Amount | 427837.06 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 385 |
| Number Of Beneficiaries Age 65 to 74 | 2129 |
| Number Of Beneficiaries Age 75 to 84 | 1291 |
| Number Of Beneficiaries Age Greater 84 | 419 |
| Number Of Female Beneficiaries | 2686 |
| Number Of Male Beneficiaries | 1538 |
| Number Of Non Hispanic White Beneficiaries | 3636 |
| Number Of Black or African American Beneficiaries | 148 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 355 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 58 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3655 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 569 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2119 |