| National Provider Identifier [NPI]: | 1184814006 |
| Last Name Of The Provider | THIERRY |
| First Name Of The Provider | ANDREW |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 857 4TH ST |
| Street Address 2 Of The Provider | APT A |
| City Of The Provider | SANTA MONICA |
| Zip Code Of The Provider | 904031201 |
| 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 | 141 |
| Number Of Services | 9610 |
| Number Of Medicare Beneficiaries | 1039 |
| Total Submitted Charge Amount | 1816993 |
| Total Medicare Allowed Amount | 291278.09 |
| Total Medicare Payment Amount | 238762.26 |
| Total Medicare Standardized Payment Amount | 214629.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 7261 |
| Number Of Medicare Beneficiaries With Drug Services | 111 |
| Total Drug Submitted ChargeAmount | 54450 |
| Total Drug Medicare AllowedAmount | 4580.32 |
| Total Drug Medicare PaymentAmount | 3590.97 |
| Total Drug Medicare Standardized Payment Amount | 3590.97 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 136 |
| Number Of Medical Services | 2349 |
| Number Of Medicare Beneficiaries With Medical Services | 1038 |
| Total Medical Submitted Charge Amount | 1762543 |
| Total Medical Medicare Allowed Amount | 286697.77 |
| Total Medical Medicare Payment Amount | 235171.29 |
| Total Medical Medicare Standardized Payment Amount | 211038.97 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 256 |
| Number Of Beneficiaries Age 65 to 74 | 541 |
| Number Of Beneficiaries Age 75 to 84 | 197 |
| Number Of Beneficiaries Age Greater 84 | 45 |
| Number Of Female Beneficiaries | 804 |
| Number Of Male Beneficiaries | 235 |
| Number Of Non Hispanic White Beneficiaries | 78 |
| Number Of Black or African American Beneficiaries | 190 |
| Number Of AsianPacific Islander Beneficiaries | 35 |
| Number Of Hispanic Beneficiaries | 720 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 100 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 939 |
| Percent Of With Atrial Fibrillation | 2 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.2535 |