| National Provider Identifier [NPI]: | 1619951829 |
| Last Name Of The Provider | MOMAH |
| First Name Of The Provider | KINGSON |
| Middle Initial Of The Provider | I |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1901 S CEDAR ST |
| Street Address 2 Of The Provider | #301 CARDIAC STUDY CENTER, INC., P.S. |
| City Of The Provider | TACOMA |
| Zip Code Of The Provider | 984052308 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 60 |
| Number Of Services | 3953 |
| Number Of Medicare Beneficiaries | 1127 |
| Total Submitted Charge Amount | 1382933.73 |
| Total Medicare Allowed Amount | 837473.64 |
| Total Medicare Payment Amount | 639046.35 |
| Total Medicare Standardized Payment Amount | 643081.11 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 594 |
| Number Of Medicare Beneficiaries With Drug Services | 150 |
| Total Drug Submitted ChargeAmount | 44550 |
| Total Drug Medicare AllowedAmount | 31478.64 |
| Total Drug Medicare PaymentAmount | 24615.88 |
| Total Drug Medicare Standardized Payment Amount | 24615.88 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 59 |
| Number Of Medical Services | 3359 |
| Number Of Medicare Beneficiaries With Medical Services | 1127 |
| Total Medical Submitted Charge Amount | 1338383.73 |
| Total Medical Medicare Allowed Amount | 805995 |
| Total Medical Medicare Payment Amount | 614430.47 |
| Total Medical Medicare Standardized Payment Amount | 618465.23 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 131 |
| Number Of Beneficiaries Age 65 to 74 | 402 |
| Number Of Beneficiaries Age 75 to 84 | 407 |
| Number Of Beneficiaries Age Greater 84 | 187 |
| Number Of Female Beneficiaries | 539 |
| Number Of Male Beneficiaries | 588 |
| Number Of Non Hispanic White Beneficiaries | 928 |
| Number Of Black or African American Beneficiaries | 87 |
| Number Of AsianPacific Islander Beneficiaries | 49 |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | 20 |
| Number Of Beneficiaries With Race Not Else where Classified | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 911 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 216 |
| Percent Of With Atrial Fibrillation | 29 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 67 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.6655 |