| National Provider Identifier [NPI]: | 1053361790 |
| Last Name Of The Provider | ELLY |
| First Name Of The Provider | MEHRAN |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D., PH.D |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 39000 BOB HOPE DR |
| Street Address 2 Of The Provider | EISENHOWER IMAGING CENTER |
| City Of The Provider | RANCHO MIRAGE |
| Zip Code Of The Provider | 922703221 |
| 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 | 247 |
| Number Of Services | 15680 |
| Number Of Medicare Beneficiaries | 1602 |
| Total Submitted Charge Amount | 1635026.18 |
| Total Medicare Allowed Amount | 460800.52 |
| Total Medicare Payment Amount | 355434.83 |
| Total Medicare Standardized Payment Amount | 349395.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 12213 |
| Number Of Medicare Beneficiaries With Drug Services | 148 |
| Total Drug Submitted ChargeAmount | 19417 |
| Total Drug Medicare AllowedAmount | 3925.6 |
| Total Drug Medicare PaymentAmount | 3077.7 |
| Total Drug Medicare Standardized Payment Amount | 3077.7 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 241 |
| Number Of Medical Services | 3467 |
| Number Of Medicare Beneficiaries With Medical Services | 1600 |
| Total Medical Submitted Charge Amount | 1615609.18 |
| Total Medical Medicare Allowed Amount | 456874.92 |
| Total Medical Medicare Payment Amount | 352357.13 |
| Total Medical Medicare Standardized Payment Amount | 346317.67 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 134 |
| Number Of Beneficiaries Age 65 to 74 | 530 |
| Number Of Beneficiaries Age 75 to 84 | 619 |
| Number Of Beneficiaries Age Greater 84 | 319 |
| Number Of Female Beneficiaries | 782 |
| Number Of Male Beneficiaries | 820 |
| Number Of Non Hispanic White Beneficiaries | 1394 |
| Number Of Black or African American Beneficiaries | 21 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 159 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1373 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 229 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 25 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.2213 |