| National Provider Identifier [NPI]: | 1063611275 |
| Last Name Of The Provider | ANDRE |
| First Name Of The Provider | JALAL |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1959 NE PACIFIC STREET, NW011 |
| Street Address 2 Of The Provider | BOX 357115 |
| City Of The Provider | SEATTLE |
| Zip Code Of The Provider | 981957115 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 76 |
| Number Of Services | 1373 |
| Number Of Medicare Beneficiaries | 950 |
| Total Submitted Charge Amount | 280382.14 |
| Total Medicare Allowed Amount | 82182.27 |
| Total Medicare Payment Amount | 60440.36 |
| Total Medicare Standardized Payment Amount | 59201.26 |
| 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 | 76 |
| Number Of Medical Services | 1373 |
| Number Of Medicare Beneficiaries With Medical Services | 950 |
| Total Medical Submitted Charge Amount | 280382.14 |
| Total Medical Medicare Allowed Amount | 82182.27 |
| Total Medical Medicare Payment Amount | 60440.36 |
| Total Medical Medicare Standardized Payment Amount | 59201.26 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 285 |
| Number Of Beneficiaries Age 65 to 74 | 370 |
| Number Of Beneficiaries Age 75 to 84 | 207 |
| Number Of Beneficiaries Age Greater 84 | 88 |
| Number Of Female Beneficiaries | 432 |
| Number Of Male Beneficiaries | 518 |
| Number Of Non Hispanic White Beneficiaries | 716 |
| Number Of Black or African American Beneficiaries | 67 |
| Number Of AsianPacific Islander Beneficiaries | 80 |
| Number Of Hispanic Beneficiaries | 44 |
| Number Of American Indian Alaska Native Beneficiaries | 16 |
| Number Of Beneficiaries With Race Not Else where Classified | 27 |
| Number Of Beneficiaries With Medicare Only Entitlement | 572 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 378 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 20 |
| Average HCC Risk Score Of Beneficiaries | 1.6555 |