| National Provider Identifier [NPI]: | 1023158128 |
| Last Name Of The Provider | FREITAS |
| First Name Of The Provider | BONNIE |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10833 LE CONTE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 900953075 |
| 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 | 104 |
| Number Of Services | 13475 |
| Number Of Medicare Beneficiaries | 1705 |
| Total Submitted Charge Amount | 3053376.22 |
| Total Medicare Allowed Amount | 496417.01 |
| Total Medicare Payment Amount | 376312.99 |
| Total Medicare Standardized Payment Amount | 340463.34 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 11234 |
| Number Of Medicare Beneficiaries With Drug Services | 359 |
| Total Drug Submitted ChargeAmount | 22891.12 |
| Total Drug Medicare AllowedAmount | 8510.51 |
| Total Drug Medicare PaymentAmount | 6629.21 |
| Total Drug Medicare Standardized Payment Amount | 6629.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 100 |
| Number Of Medical Services | 2241 |
| Number Of Medicare Beneficiaries With Medical Services | 1704 |
| Total Medical Submitted Charge Amount | 3030485.1 |
| Total Medical Medicare Allowed Amount | 487906.5 |
| Total Medical Medicare Payment Amount | 369683.78 |
| Total Medical Medicare Standardized Payment Amount | 333834.13 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 248 |
| Number Of Beneficiaries Age 65 to 74 | 703 |
| Number Of Beneficiaries Age 75 to 84 | 524 |
| Number Of Beneficiaries Age Greater 84 | 230 |
| Number Of Female Beneficiaries | 1050 |
| Number Of Male Beneficiaries | 655 |
| Number Of Non Hispanic White Beneficiaries | 1053 |
| Number Of Black or African American Beneficiaries | 59 |
| Number Of AsianPacific Islander Beneficiaries | 228 |
| Number Of Hispanic Beneficiaries | 306 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 944 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 761 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.4982 |