| National Provider Identifier [NPI]: | 1265455505 |
| Last Name Of The Provider | RAEL |
| First Name Of The Provider | JESSE |
| 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 | 4901 LANG AVE NE |
| Street Address 2 Of The Provider | |
| City Of The Provider | ALBUQUERQUE |
| Zip Code Of The Provider | 87109 |
| State Code Of The Provider | NM |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 112 |
| Number Of Services | 13472 |
| Number Of Medicare Beneficiaries | 948 |
| Total Submitted Charge Amount | 1094644 |
| Total Medicare Allowed Amount | 237594.07 |
| Total Medicare Payment Amount | 181850.34 |
| Total Medicare Standardized Payment Amount | 174239.64 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 12110 |
| Number Of Medicare Beneficiaries With Drug Services | 168 |
| Total Drug Submitted ChargeAmount | 17396 |
| Total Drug Medicare AllowedAmount | 4242.77 |
| Total Drug Medicare PaymentAmount | 3302.22 |
| Total Drug Medicare Standardized Payment Amount | 3302.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 108 |
| Number Of Medical Services | 1362 |
| Number Of Medicare Beneficiaries With Medical Services | 948 |
| Total Medical Submitted Charge Amount | 1077248 |
| Total Medical Medicare Allowed Amount | 233351.3 |
| Total Medical Medicare Payment Amount | 178548.12 |
| Total Medical Medicare Standardized Payment Amount | 170937.42 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 128 |
| Number Of Beneficiaries Age 65 to 74 | 500 |
| Number Of Beneficiaries Age 75 to 84 | 230 |
| Number Of Beneficiaries Age Greater 84 | 90 |
| Number Of Female Beneficiaries | 613 |
| Number Of Male Beneficiaries | 335 |
| Number Of Non Hispanic White Beneficiaries | 835 |
| Number Of Black or African American Beneficiaries | 12 |
| Number Of AsianPacific Islander Beneficiaries | 16 |
| Number Of Hispanic Beneficiaries | 59 |
| Number Of American Indian Alaska Native Beneficiaries | 12 |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 792 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 156 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 26 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1475 |