| National Provider Identifier [NPI]: | 1538365747 |
| Last Name Of The Provider | TABOADA |
| First Name Of The Provider | JORGE |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 300 UNIVERSITY BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROUND ROCK |
| Zip Code Of The Provider | 786651032 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 193 |
| Number Of Services | 1910 |
| Number Of Medicare Beneficiaries | 1184 |
| Total Submitted Charge Amount | 1002268 |
| Total Medicare Allowed Amount | 110492.97 |
| Total Medicare Payment Amount | 83233.23 |
| Total Medicare Standardized Payment Amount | 85448.2 |
| 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 | 193 |
| Number Of Medical Services | 1910 |
| Number Of Medicare Beneficiaries With Medical Services | 1184 |
| Total Medical Submitted Charge Amount | 1002268 |
| Total Medical Medicare Allowed Amount | 110492.97 |
| Total Medical Medicare Payment Amount | 83233.23 |
| Total Medical Medicare Standardized Payment Amount | 85448.2 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 136 |
| Number Of Beneficiaries Age 65 to 74 | 476 |
| Number Of Beneficiaries Age 75 to 84 | 380 |
| Number Of Beneficiaries Age Greater 84 | 192 |
| Number Of Female Beneficiaries | 665 |
| Number Of Male Beneficiaries | 519 |
| Number Of Non Hispanic White Beneficiaries | 1019 |
| Number Of Black or African American Beneficiaries | 60 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 83 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 992 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 192 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.5682 |