| National Provider Identifier [NPI]: | 1740292234 |
| Last Name Of The Provider | LEE |
| First Name Of The Provider | JEAN |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1959 NE PACIFIC ST |
| Street Address 2 Of The Provider | C212, BOX 356340 |
| City Of The Provider | SEATTLE |
| Zip Code Of The Provider | 981956340 |
| 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 | 48 |
| Number Of Services | 1298 |
| Number Of Medicare Beneficiaries | 882 |
| Total Submitted Charge Amount | 277090.8 |
| Total Medicare Allowed Amount | 88930.71 |
| Total Medicare Payment Amount | 63270.82 |
| Total Medicare Standardized Payment Amount | 62225.78 |
| 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 | 48 |
| Number Of Medical Services | 1298 |
| Number Of Medicare Beneficiaries With Medical Services | 882 |
| Total Medical Submitted Charge Amount | 277090.8 |
| Total Medical Medicare Allowed Amount | 88930.71 |
| Total Medical Medicare Payment Amount | 63270.82 |
| Total Medical Medicare Standardized Payment Amount | 62225.78 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 267 |
| Number Of Beneficiaries Age 65 to 74 | 401 |
| Number Of Beneficiaries Age 75 to 84 | 168 |
| Number Of Beneficiaries Age Greater 84 | 46 |
| Number Of Female Beneficiaries | 419 |
| Number Of Male Beneficiaries | 463 |
| Number Of Non Hispanic White Beneficiaries | 694 |
| Number Of Black or African American Beneficiaries | 45 |
| Number Of AsianPacific Islander Beneficiaries | 63 |
| Number Of Hispanic Beneficiaries | 32 |
| Number Of American Indian Alaska Native Beneficiaries | 11 |
| Number Of Beneficiaries With Race Not Else where Classified | 37 |
| Number Of Beneficiaries With Medicare Only Entitlement | 607 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 275 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 22 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 22 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 2.3683 |