| National Provider Identifier [NPI]: | 1407021512 |
| Last Name Of The Provider | DEROCHE |
| First Name Of The Provider | TOM |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 34800 BOB WILSON DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAN DIEGO |
| Zip Code Of The Provider | 921341098 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 19 |
| Number Of Services | 1746 |
| Number Of Medicare Beneficiaries | 700 |
| Total Submitted Charge Amount | 274094 |
| Total Medicare Allowed Amount | 68799.71 |
| Total Medicare Payment Amount | 52221.73 |
| Total Medicare Standardized Payment Amount | 42167.53 |
| 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 | 19 |
| Number Of Medical Services | 1746 |
| Number Of Medicare Beneficiaries With Medical Services | 700 |
| Total Medical Submitted Charge Amount | 274094 |
| Total Medical Medicare Allowed Amount | 68799.71 |
| Total Medical Medicare Payment Amount | 52221.73 |
| Total Medical Medicare Standardized Payment Amount | 42167.53 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 189 |
| Number Of Beneficiaries Age 65 to 74 | 321 |
| Number Of Beneficiaries Age 75 to 84 | 156 |
| Number Of Beneficiaries Age Greater 84 | 34 |
| Number Of Female Beneficiaries | 325 |
| Number Of Male Beneficiaries | 375 |
| Number Of Non Hispanic White Beneficiaries | 558 |
| Number Of Black or African American Beneficiaries | 118 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 517 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 183 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.7897 |