| National Provider Identifier [NPI]: | 1861549743 |
| Last Name Of The Provider | PACK |
| First Name Of The Provider | JASON |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2825 PARKLAWN DR |
| Street Address 2 Of The Provider | RADIOLOGY DEPT. |
| City Of The Provider | MIDWEST CITY |
| Zip Code Of The Provider | 731104201 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 182 |
| Number Of Services | 10811 |
| Number Of Medicare Beneficiaries | 3349 |
| Total Submitted Charge Amount | 1744774 |
| Total Medicare Allowed Amount | 305820.77 |
| Total Medicare Payment Amount | 226082.92 |
| Total Medicare Standardized Payment Amount | 254030.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 6142 |
| Number Of Medicare Beneficiaries With Drug Services | 105 |
| Total Drug Submitted ChargeAmount | 18283 |
| Total Drug Medicare AllowedAmount | 2899.84 |
| Total Drug Medicare PaymentAmount | 2024.44 |
| Total Drug Medicare Standardized Payment Amount | 2024.44 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 179 |
| Number Of Medical Services | 4669 |
| Number Of Medicare Beneficiaries With Medical Services | 3349 |
| Total Medical Submitted Charge Amount | 1726491 |
| Total Medical Medicare Allowed Amount | 302920.93 |
| Total Medical Medicare Payment Amount | 224058.48 |
| Total Medical Medicare Standardized Payment Amount | 252006.53 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 846 |
| Number Of Beneficiaries Age 65 to 74 | 1298 |
| Number Of Beneficiaries Age 75 to 84 | 852 |
| Number Of Beneficiaries Age Greater 84 | 353 |
| Number Of Female Beneficiaries | 2074 |
| Number Of Male Beneficiaries | 1275 |
| Number Of Non Hispanic White Beneficiaries | 2780 |
| Number Of Black or African American Beneficiaries | 241 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 83 |
| Number Of American Indian Alaska Native Beneficiaries | 196 |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2319 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1030 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5282 |