| National Provider Identifier [NPI]: | 1871683326 |
| Last Name Of The Provider | MODIC |
| First Name Of The Provider | FRANK |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 121 SOTOYOME ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SANTA ROSA |
| Zip Code Of The Provider | 954054823 |
| 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 | 225 |
| Number Of Services | 14072 |
| Number Of Medicare Beneficiaries | 4077 |
| Total Submitted Charge Amount | 832170.5 |
| Total Medicare Allowed Amount | 390756.84 |
| Total Medicare Payment Amount | 290389.33 |
| Total Medicare Standardized Payment Amount | 286082.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 7479 |
| Number Of Medicare Beneficiaries With Drug Services | 80 |
| Total Drug Submitted ChargeAmount | 16025 |
| Total Drug Medicare AllowedAmount | 1608.42 |
| Total Drug Medicare PaymentAmount | 1260.8 |
| Total Drug Medicare Standardized Payment Amount | 1260.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 219 |
| Number Of Medical Services | 6593 |
| Number Of Medicare Beneficiaries With Medical Services | 4077 |
| Total Medical Submitted Charge Amount | 816145.5 |
| Total Medical Medicare Allowed Amount | 389148.42 |
| Total Medical Medicare Payment Amount | 289128.53 |
| Total Medical Medicare Standardized Payment Amount | 284821.47 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 591 |
| Number Of Beneficiaries Age 65 to 74 | 1504 |
| Number Of Beneficiaries Age 75 to 84 | 1113 |
| Number Of Beneficiaries Age Greater 84 | 869 |
| Number Of Female Beneficiaries | 2364 |
| Number Of Male Beneficiaries | 1713 |
| Number Of Non Hispanic White Beneficiaries | 3558 |
| Number Of Black or African American Beneficiaries | 46 |
| Number Of AsianPacific Islander Beneficiaries | 59 |
| Number Of Hispanic Beneficiaries | 313 |
| Number Of American Indian Alaska Native Beneficiaries | 49 |
| Number Of Beneficiaries With Race Not Else where Classified | 52 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3056 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1021 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5552 |