| National Provider Identifier [NPI]: | 1225024698 |
| Last Name Of The Provider | LO |
| First Name Of The Provider | LAWRENCE |
| 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 | 267 GRANT ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BRIDGEPORT |
| Zip Code Of The Provider | 066102805 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 143 |
| Number Of Services | 20691 |
| Number Of Medicare Beneficiaries | 2284 |
| Total Submitted Charge Amount | 1437307.41 |
| Total Medicare Allowed Amount | 391618.31 |
| Total Medicare Payment Amount | 301387.42 |
| Total Medicare Standardized Payment Amount | 281424.2 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 17354 |
| Number Of Medicare Beneficiaries With Drug Services | 193 |
| Total Drug Submitted ChargeAmount | 13856.41 |
| Total Drug Medicare AllowedAmount | 5609.98 |
| Total Drug Medicare PaymentAmount | 4357.53 |
| Total Drug Medicare Standardized Payment Amount | 4357.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 139 |
| Number Of Medical Services | 3337 |
| Number Of Medicare Beneficiaries With Medical Services | 2284 |
| Total Medical Submitted Charge Amount | 1423451 |
| Total Medical Medicare Allowed Amount | 386008.33 |
| Total Medical Medicare Payment Amount | 297029.89 |
| Total Medical Medicare Standardized Payment Amount | 277066.67 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 366 |
| Number Of Beneficiaries Age 65 to 74 | 850 |
| Number Of Beneficiaries Age 75 to 84 | 668 |
| Number Of Beneficiaries Age Greater 84 | 400 |
| Number Of Female Beneficiaries | 1302 |
| Number Of Male Beneficiaries | 982 |
| Number Of Non Hispanic White Beneficiaries | 1710 |
| Number Of Black or African American Beneficiaries | 231 |
| Number Of AsianPacific Islander Beneficiaries | 34 |
| Number Of Hispanic Beneficiaries | 255 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 54 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1562 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 722 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.7301 |