| National Provider Identifier [NPI]: | 1841243912 |
| Last Name Of The Provider | DOEMENY |
| First Name Of The Provider | JOHN |
| 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 | 501 WASHINGTON ST |
| Street Address 2 Of The Provider | STE 510 |
| City Of The Provider | SAN DIEGO |
| Zip Code Of The Provider | 921032231 |
| 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 | 182 |
| Number Of Services | 1603 |
| Number Of Medicare Beneficiaries | 708 |
| Total Submitted Charge Amount | 542467.13 |
| Total Medicare Allowed Amount | 137112.39 |
| Total Medicare Payment Amount | 102522.12 |
| Total Medicare Standardized Payment Amount | 101502.1 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 193 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 481 |
| Total Drug Medicare AllowedAmount | 42.02 |
| Total Drug Medicare PaymentAmount | 32.96 |
| Total Drug Medicare Standardized Payment Amount | 32.96 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 179 |
| Number Of Medical Services | 1410 |
| Number Of Medicare Beneficiaries With Medical Services | 708 |
| Total Medical Submitted Charge Amount | 541986.13 |
| Total Medical Medicare Allowed Amount | 137070.37 |
| Total Medical Medicare Payment Amount | 102489.16 |
| Total Medical Medicare Standardized Payment Amount | 101469.14 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 153 |
| Number Of Beneficiaries Age 65 to 74 | 249 |
| Number Of Beneficiaries Age 75 to 84 | 194 |
| Number Of Beneficiaries Age Greater 84 | 112 |
| Number Of Female Beneficiaries | 341 |
| Number Of Male Beneficiaries | 367 |
| Number Of Non Hispanic White Beneficiaries | 442 |
| Number Of Black or African American Beneficiaries | 82 |
| Number Of AsianPacific Islander Beneficiaries | 31 |
| Number Of Hispanic Beneficiaries | 133 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 364 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 344 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.755 |