| National Provider Identifier [NPI]: | 1821040866 |
| Last Name Of The Provider | PHAM |
| First Name Of The Provider | JUSTIN |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 100 BAYVIEW CIR STE 400 |
| Street Address 2 Of The Provider | |
| City Of The Provider | NEWPORT BEACH |
| Zip Code Of The Provider | 926602984 |
| 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 | 150 |
| Number Of Services | 6512 |
| Number Of Medicare Beneficiaries | 3985 |
| Total Submitted Charge Amount | 556740.08 |
| Total Medicare Allowed Amount | 170913.79 |
| Total Medicare Payment Amount | 127373.61 |
| Total Medicare Standardized Payment Amount | 124146.07 |
| 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 | 150 |
| Number Of Medical Services | 6512 |
| Number Of Medicare Beneficiaries With Medical Services | 3985 |
| Total Medical Submitted Charge Amount | 556740.08 |
| Total Medical Medicare Allowed Amount | 170913.79 |
| Total Medical Medicare Payment Amount | 127373.61 |
| Total Medical Medicare Standardized Payment Amount | 124146.07 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 776 |
| Number Of Beneficiaries Age 65 to 74 | 1105 |
| Number Of Beneficiaries Age 75 to 84 | 1212 |
| Number Of Beneficiaries Age Greater 84 | 892 |
| Number Of Female Beneficiaries | 2292 |
| Number Of Male Beneficiaries | 1693 |
| Number Of Non Hispanic White Beneficiaries | 2735 |
| Number Of Black or African American Beneficiaries | 545 |
| Number Of AsianPacific Islander Beneficiaries | 37 |
| Number Of Hispanic Beneficiaries | 635 |
| Number Of American Indian Alaska Native Beneficiaries | 18 |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1997 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1988 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 39 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 18 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.1869 |