| National Provider Identifier [NPI]: | 1043284235 |
| Last Name Of The Provider | PUCKETT |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8745 AERO DR |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | SAN DIEGO |
| Zip Code Of The Provider | 921231774 |
| 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 | 184 |
| Number Of Services | 15673 |
| Number Of Medicare Beneficiaries | 2132 |
| Total Submitted Charge Amount | 636055.74 |
| Total Medicare Allowed Amount | 190572.44 |
| Total Medicare Payment Amount | 141160.09 |
| Total Medicare Standardized Payment Amount | 136555.34 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 12300 |
| Number Of Medicare Beneficiaries With Drug Services | 108 |
| Total Drug Submitted ChargeAmount | 15744 |
| Total Drug Medicare AllowedAmount | 2336.73 |
| Total Drug Medicare PaymentAmount | 1817.86 |
| Total Drug Medicare Standardized Payment Amount | 1817.86 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 183 |
| Number Of Medical Services | 3373 |
| Number Of Medicare Beneficiaries With Medical Services | 2132 |
| Total Medical Submitted Charge Amount | 620311.74 |
| Total Medical Medicare Allowed Amount | 188235.71 |
| Total Medical Medicare Payment Amount | 139342.23 |
| Total Medical Medicare Standardized Payment Amount | 134737.48 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 326 |
| Number Of Beneficiaries Age 65 to 74 | 747 |
| Number Of Beneficiaries Age 75 to 84 | 660 |
| Number Of Beneficiaries Age Greater 84 | 399 |
| Number Of Female Beneficiaries | 1187 |
| Number Of Male Beneficiaries | 945 |
| Number Of Non Hispanic White Beneficiaries | 1294 |
| Number Of Black or African American Beneficiaries | 112 |
| Number Of AsianPacific Islander Beneficiaries | 240 |
| Number Of Hispanic Beneficiaries | 415 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1314 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 818 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.0265 |