| National Provider Identifier [NPI]: | 1619054475 |
| Last Name Of The Provider | TERESI |
| First Name Of The Provider | LOUIS |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1605 AVOCADO |
| Street Address 2 Of The Provider | |
| City Of The Provider | NEWPORT BEACH |
| Zip Code Of The Provider | 92660 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 74 |
| Number Of Services | 27468 |
| Number Of Medicare Beneficiaries | 1008 |
| Total Submitted Charge Amount | 1923429.6 |
| Total Medicare Allowed Amount | 906894.79 |
| Total Medicare Payment Amount | 704879.7 |
| Total Medicare Standardized Payment Amount | 632069.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 25325 |
| Number Of Medicare Beneficiaries With Drug Services | 207 |
| Total Drug Submitted ChargeAmount | 39159.6 |
| Total Drug Medicare AllowedAmount | 4869.5 |
| Total Drug Medicare PaymentAmount | 3782.83 |
| Total Drug Medicare Standardized Payment Amount | 3782.83 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 71 |
| Number Of Medical Services | 2143 |
| Number Of Medicare Beneficiaries With Medical Services | 1001 |
| Total Medical Submitted Charge Amount | 1884270 |
| Total Medical Medicare Allowed Amount | 902025.29 |
| Total Medical Medicare Payment Amount | 701096.87 |
| Total Medical Medicare Standardized Payment Amount | 628286.65 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 63 |
| Number Of Beneficiaries Age 65 to 74 | 426 |
| Number Of Beneficiaries Age 75 to 84 | 387 |
| Number Of Beneficiaries Age Greater 84 | 132 |
| Number Of Female Beneficiaries | 546 |
| Number Of Male Beneficiaries | 462 |
| Number Of Non Hispanic White Beneficiaries | 883 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 45 |
| Number Of Hispanic Beneficiaries | 45 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 946 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 62 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.4604 |