| National Provider Identifier [NPI]: | 1538208574 |
| Last Name Of The Provider | HALTOM |
| First Name Of The Provider | STEPHEN |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1025 EL MIRADOR AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | LONG BEACH |
| Zip Code Of The Provider | 908154420 |
| 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 | 3139 |
| Number Of Medicare Beneficiaries | 2101 |
| Total Submitted Charge Amount | 655318.06 |
| Total Medicare Allowed Amount | 140375.09 |
| Total Medicare Payment Amount | 106036.52 |
| Total Medicare Standardized Payment Amount | 100755.36 |
| 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 | 3139 |
| Number Of Medicare Beneficiaries With Medical Services | 2101 |
| Total Medical Submitted Charge Amount | 655318.06 |
| Total Medical Medicare Allowed Amount | 140375.09 |
| Total Medical Medicare Payment Amount | 106036.52 |
| Total Medical Medicare Standardized Payment Amount | 100755.36 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 212 |
| Number Of Beneficiaries Age 65 to 74 | 723 |
| Number Of Beneficiaries Age 75 to 84 | 698 |
| Number Of Beneficiaries Age Greater 84 | 468 |
| Number Of Female Beneficiaries | 1231 |
| Number Of Male Beneficiaries | 870 |
| Number Of Non Hispanic White Beneficiaries | 1299 |
| Number Of Black or African American Beneficiaries | 164 |
| Number Of AsianPacific Islander Beneficiaries | 306 |
| Number Of Hispanic Beneficiaries | 254 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1644 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 457 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.7752 |