| National Provider Identifier [NPI]: | 1679512750 |
| Last Name Of The Provider | BARACK |
| First Name Of The Provider | BRUCE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1520 SAN PABLO ST |
| Street Address 2 Of The Provider | LOWER LEVEL , STE 1600 |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 900335310 |
| 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 | 4 |
| Number Of Services | 2834 |
| Number Of Medicare Beneficiaries | 1618 |
| Total Submitted Charge Amount | 91823 |
| Total Medicare Allowed Amount | 29560.72 |
| Total Medicare Payment Amount | 22458.69 |
| Total Medicare Standardized Payment Amount | 21204.18 |
| 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 | 4 |
| Number Of Medical Services | 2834 |
| Number Of Medicare Beneficiaries With Medical Services | 1618 |
| Total Medical Submitted Charge Amount | 91823 |
| Total Medical Medicare Allowed Amount | 29560.72 |
| Total Medical Medicare Payment Amount | 22458.69 |
| Total Medical Medicare Standardized Payment Amount | 21204.18 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 384 |
| Number Of Beneficiaries Age 65 to 74 | 652 |
| Number Of Beneficiaries Age 75 to 84 | 431 |
| Number Of Beneficiaries Age Greater 84 | 151 |
| Number Of Female Beneficiaries | 737 |
| Number Of Male Beneficiaries | 881 |
| Number Of Non Hispanic White Beneficiaries | 814 |
| Number Of Black or African American Beneficiaries | 95 |
| Number Of AsianPacific Islander Beneficiaries | 188 |
| Number Of Hispanic Beneficiaries | 476 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 869 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 749 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 53 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.5301 |