| National Provider Identifier [NPI]: | 1588691745 |
| Last Name Of The Provider | HOLT |
| First Name Of The Provider | DANICA |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1509 W CAMERON AVE |
| Street Address 2 Of The Provider | SUITE D |
| City Of The Provider | WEST COVINA |
| Zip Code Of The Provider | 917902725 |
| 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 | 107 |
| Number Of Services | 8000 |
| Number Of Medicare Beneficiaries | 925 |
| Total Submitted Charge Amount | 829495.1 |
| Total Medicare Allowed Amount | 220345.69 |
| Total Medicare Payment Amount | 161965.63 |
| Total Medicare Standardized Payment Amount | 144225.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 6446 |
| Number Of Medicare Beneficiaries With Drug Services | 76 |
| Total Drug Submitted ChargeAmount | 2094.1 |
| Total Drug Medicare AllowedAmount | 1779.95 |
| Total Drug Medicare PaymentAmount | 1395.36 |
| Total Drug Medicare Standardized Payment Amount | 1395.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 105 |
| Number Of Medical Services | 1554 |
| Number Of Medicare Beneficiaries With Medical Services | 925 |
| Total Medical Submitted Charge Amount | 827401 |
| Total Medical Medicare Allowed Amount | 218565.74 |
| Total Medical Medicare Payment Amount | 160570.27 |
| Total Medical Medicare Standardized Payment Amount | 142829.82 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 181 |
| Number Of Beneficiaries Age 65 to 74 | 338 |
| Number Of Beneficiaries Age 75 to 84 | 300 |
| Number Of Beneficiaries Age Greater 84 | 106 |
| Number Of Female Beneficiaries | 583 |
| Number Of Male Beneficiaries | 342 |
| Number Of Non Hispanic White Beneficiaries | 242 |
| Number Of Black or African American Beneficiaries | 31 |
| Number Of AsianPacific Islander Beneficiaries | 110 |
| Number Of Hispanic Beneficiaries | 525 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 358 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 567 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4715 |