| National Provider Identifier [NPI]: | 1801006523 |
| Last Name Of The Provider | GOMEZ |
| First Name Of The Provider | CONAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 712 N WASHINGTON AVE |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | DALLAS |
| Zip Code Of The Provider | 752461619 |
| 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 | 53 |
| Number Of Services | 2856 |
| Number Of Medicare Beneficiaries | 1560 |
| Total Submitted Charge Amount | 630045.56 |
| Total Medicare Allowed Amount | 149319.07 |
| Total Medicare Payment Amount | 113996.99 |
| Total Medicare Standardized Payment Amount | 118077.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 592 |
| Number Of Medicare Beneficiaries With Drug Services | 24 |
| Total Drug Submitted ChargeAmount | 4231.98 |
| Total Drug Medicare AllowedAmount | 459.11 |
| Total Drug Medicare PaymentAmount | 347.89 |
| Total Drug Medicare Standardized Payment Amount | 347.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 47 |
| Number Of Medical Services | 2264 |
| Number Of Medicare Beneficiaries With Medical Services | 1560 |
| Total Medical Submitted Charge Amount | 625813.58 |
| Total Medical Medicare Allowed Amount | 148859.96 |
| Total Medical Medicare Payment Amount | 113649.1 |
| Total Medical Medicare Standardized Payment Amount | 117729.73 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 292 |
| Number Of Beneficiaries Age 65 to 74 | 594 |
| Number Of Beneficiaries Age 75 to 84 | 453 |
| Number Of Beneficiaries Age Greater 84 | 221 |
| Number Of Female Beneficiaries | 888 |
| Number Of Male Beneficiaries | 672 |
| Number Of Non Hispanic White Beneficiaries | 1102 |
| Number Of Black or African American Beneficiaries | 315 |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | 115 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1161 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 399 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 29 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 28 |
| Average HCC Risk Score Of Beneficiaries | 1.8776 |