| National Provider Identifier [NPI]: | 1114124690 |
| Last Name Of The Provider | MCCULLOCH |
| First Name Of The Provider | MADISON |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 19020 33RD AVE W |
| Street Address 2 Of The Provider | SUITE 210 |
| City Of The Provider | LYNNWOOD |
| Zip Code Of The Provider | 980364746 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 139 |
| Number Of Services | 5181 |
| Number Of Medicare Beneficiaries | 3453 |
| Total Submitted Charge Amount | 721886.98 |
| Total Medicare Allowed Amount | 125353.94 |
| Total Medicare Payment Amount | 97620.11 |
| Total Medicare Standardized Payment Amount | 100373.72 |
| 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 | 139 |
| Number Of Medical Services | 5181 |
| Number Of Medicare Beneficiaries With Medical Services | 3453 |
| Total Medical Submitted Charge Amount | 721886.98 |
| Total Medical Medicare Allowed Amount | 125353.94 |
| Total Medical Medicare Payment Amount | 97620.11 |
| Total Medical Medicare Standardized Payment Amount | 100373.72 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 564 |
| Number Of Beneficiaries Age 65 to 74 | 1251 |
| Number Of Beneficiaries Age 75 to 84 | 1028 |
| Number Of Beneficiaries Age Greater 84 | 610 |
| Number Of Female Beneficiaries | 2096 |
| Number Of Male Beneficiaries | 1357 |
| Number Of Non Hispanic White Beneficiaries | 3206 |
| Number Of Black or African American Beneficiaries | 43 |
| Number Of AsianPacific Islander Beneficiaries | 52 |
| Number Of Hispanic Beneficiaries | 66 |
| Number Of American Indian Alaska Native Beneficiaries | 44 |
| Number Of Beneficiaries With Race Not Else where Classified | 42 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2695 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 758 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.5105 |