| National Provider Identifier [NPI]: | 1316920697 |
| Last Name Of The Provider | CHAIN |
| First Name Of The Provider | VICKI |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4111 S DARLINGTON AVE |
| Street Address 2 Of The Provider | STE 700 |
| City Of The Provider | TULSA |
| Zip Code Of The Provider | 741356348 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 112 |
| Number Of Services | 4878 |
| Number Of Medicare Beneficiaries | 3796 |
| Total Submitted Charge Amount | 318087 |
| Total Medicare Allowed Amount | 111963.04 |
| Total Medicare Payment Amount | 84335.28 |
| Total Medicare Standardized Payment Amount | 90597.8 |
| 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 | 112 |
| Number Of Medical Services | 4878 |
| Number Of Medicare Beneficiaries With Medical Services | 3796 |
| Total Medical Submitted Charge Amount | 318087 |
| Total Medical Medicare Allowed Amount | 111963.04 |
| Total Medical Medicare Payment Amount | 84335.28 |
| Total Medical Medicare Standardized Payment Amount | 90597.8 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 636 |
| Number Of Beneficiaries Age 65 to 74 | 1492 |
| Number Of Beneficiaries Age 75 to 84 | 1058 |
| Number Of Beneficiaries Age Greater 84 | 610 |
| Number Of Female Beneficiaries | 2399 |
| Number Of Male Beneficiaries | 1397 |
| Number Of Non Hispanic White Beneficiaries | 3161 |
| Number Of Black or African American Beneficiaries | 270 |
| Number Of AsianPacific Islander Beneficiaries | 16 |
| Number Of Hispanic Beneficiaries | 51 |
| Number Of American Indian Alaska Native Beneficiaries | 269 |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2936 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 860 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.5229 |