| National Provider Identifier [NPI]: | 1174649206 |
| Last Name Of The Provider | LIVERMORE |
| First Name Of The Provider | JACOB |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5333 MCAULEY DR |
| Street Address 2 Of The Provider | SUITE 6016 |
| City Of The Provider | YPSILANTI |
| Zip Code Of The Provider | 481971014 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 150 |
| Number Of Services | 4969 |
| Number Of Medicare Beneficiaries | 3660 |
| Total Submitted Charge Amount | 509564 |
| Total Medicare Allowed Amount | 176703.32 |
| Total Medicare Payment Amount | 131914.79 |
| Total Medicare Standardized Payment Amount | 129709.49 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 150 |
| Number Of Medical Services | 4969 |
| Number Of Medicare Beneficiaries With Medical Services | 3660 |
| Total Medical Submitted Charge Amount | 509564 |
| Total Medical Medicare Allowed Amount | 176703.32 |
| Total Medical Medicare Payment Amount | 131914.79 |
| Total Medical Medicare Standardized Payment Amount | 129709.49 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 691 |
| Number Of Beneficiaries Age 65 to 74 | 1276 |
| Number Of Beneficiaries Age 75 to 84 | 1018 |
| Number Of Beneficiaries Age Greater 84 | 675 |
| Number Of Female Beneficiaries | 2216 |
| Number Of Male Beneficiaries | 1444 |
| Number Of Non Hispanic White Beneficiaries | 3192 |
| Number Of Black or African American Beneficiaries | 329 |
| Number Of AsianPacific Islander Beneficiaries | 43 |
| Number Of Hispanic Beneficiaries | 57 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2923 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 737 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.8306 |