| National Provider Identifier [NPI]: | 1124281761 |
| Last Name Of The Provider | DODAKIAN |
| First Name Of The Provider | WAYNE |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5451 WALNUT AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHINO |
| Zip Code Of The Provider | 917102609 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 934 |
| Number Of Medicare Beneficiaries | 396 |
| Total Submitted Charge Amount | 145036 |
| Total Medicare Allowed Amount | 98402.53 |
| Total Medicare Payment Amount | 77123.3 |
| Total Medicare Standardized Payment Amount | 75392.04 |
| 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 | 27 |
| Number Of Medical Services | 934 |
| Number Of Medicare Beneficiaries With Medical Services | 396 |
| Total Medical Submitted Charge Amount | 145036 |
| Total Medical Medicare Allowed Amount | 98402.53 |
| Total Medical Medicare Payment Amount | 77123.3 |
| Total Medical Medicare Standardized Payment Amount | 75392.04 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 117 |
| Number Of Beneficiaries Age 65 to 74 | 104 |
| Number Of Beneficiaries Age 75 to 84 | 101 |
| Number Of Beneficiaries Age Greater 84 | 74 |
| Number Of Female Beneficiaries | 221 |
| Number Of Male Beneficiaries | 175 |
| Number Of Non Hispanic White Beneficiaries | 138 |
| Number Of Black or African American Beneficiaries | 62 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 153 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 104 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 292 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 36 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 55 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 65 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 18 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 3.0315 |