| National Provider Identifier [NPI]: | 1770712259 |
| Last Name Of The Provider | LOPEZ-COSTA |
| First Name Of The Provider | RODRIGO |
| Middle Initial Of The Provider | I |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 510 S KINGSHIGHWAY BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAINT LOUIS |
| Zip Code Of The Provider | 631101016 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 180 |
| Number Of Services | 5996 |
| Number Of Medicare Beneficiaries | 3118 |
| Total Submitted Charge Amount | 581330 |
| Total Medicare Allowed Amount | 165598.84 |
| Total Medicare Payment Amount | 129232.25 |
| Total Medicare Standardized Payment Amount | 135968.01 |
| 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 | 180 |
| Number Of Medical Services | 5996 |
| Number Of Medicare Beneficiaries With Medical Services | 3118 |
| Total Medical Submitted Charge Amount | 581330 |
| Total Medical Medicare Allowed Amount | 165598.84 |
| Total Medical Medicare Payment Amount | 129232.25 |
| Total Medical Medicare Standardized Payment Amount | 135968.01 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 948 |
| Number Of Beneficiaries Age 65 to 74 | 1138 |
| Number Of Beneficiaries Age 75 to 84 | 693 |
| Number Of Beneficiaries Age Greater 84 | 339 |
| Number Of Female Beneficiaries | 1937 |
| Number Of Male Beneficiaries | 1181 |
| Number Of Non Hispanic White Beneficiaries | 2552 |
| Number Of Black or African American Beneficiaries | 514 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 19 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1839 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1279 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.8776 |