| National Provider Identifier [NPI]: | 1669411732 |
| Last Name Of The Provider | SODERSTROM |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7026 OLD KATY RD |
| Street Address 2 Of The Provider | SUITE 276 |
| City Of The Provider | HOUSTON |
| Zip Code Of The Provider | 770242133 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 160 |
| Number Of Services | 9778 |
| Number Of Medicare Beneficiaries | 2969 |
| Total Submitted Charge Amount | 578851.01 |
| Total Medicare Allowed Amount | 144805 |
| Total Medicare Payment Amount | 109611.38 |
| Total Medicare Standardized Payment Amount | 110303.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 5200 |
| Number Of Medicare Beneficiaries With Drug Services | 52 |
| Total Drug Submitted ChargeAmount | 1773 |
| Total Drug Medicare AllowedAmount | 1098.4 |
| Total Drug Medicare PaymentAmount | 861.04 |
| Total Drug Medicare Standardized Payment Amount | 861.04 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 158 |
| Number Of Medical Services | 4578 |
| Number Of Medicare Beneficiaries With Medical Services | 2969 |
| Total Medical Submitted Charge Amount | 577078.01 |
| Total Medical Medicare Allowed Amount | 143706.6 |
| Total Medical Medicare Payment Amount | 108750.34 |
| Total Medical Medicare Standardized Payment Amount | 109441.99 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 673 |
| Number Of Beneficiaries Age 65 to 74 | 908 |
| Number Of Beneficiaries Age 75 to 84 | 806 |
| Number Of Beneficiaries Age Greater 84 | 582 |
| Number Of Female Beneficiaries | 1685 |
| Number Of Male Beneficiaries | 1284 |
| Number Of Non Hispanic White Beneficiaries | 1335 |
| Number Of Black or African American Beneficiaries | 842 |
| Number Of AsianPacific Islander Beneficiaries | 219 |
| Number Of Hispanic Beneficiaries | 548 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1732 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1237 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 30 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 48 |
| Percent Of With Chronic Kidney Disease | 53 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 56 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 2.5899 |