| National Provider Identifier [NPI]: | 1891753497 |
| Last Name Of The Provider | LASTINE |
| First Name Of The Provider | CRAIG |
| 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 | 2021 N 12TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | GRAND JUNCTION |
| Zip Code Of The Provider | 815012980 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 190 |
| Number Of Services | 3253 |
| Number Of Medicare Beneficiaries | 1770 |
| Total Submitted Charge Amount | 308003 |
| Total Medicare Allowed Amount | 99188.78 |
| Total Medicare Payment Amount | 73796.74 |
| Total Medicare Standardized Payment Amount | 75056.58 |
| 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 | 190 |
| Number Of Medical Services | 3253 |
| Number Of Medicare Beneficiaries With Medical Services | 1770 |
| Total Medical Submitted Charge Amount | 308003 |
| Total Medical Medicare Allowed Amount | 99188.78 |
| Total Medical Medicare Payment Amount | 73796.74 |
| Total Medical Medicare Standardized Payment Amount | 75056.58 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 276 |
| Number Of Beneficiaries Age 65 to 74 | 799 |
| Number Of Beneficiaries Age 75 to 84 | 456 |
| Number Of Beneficiaries Age Greater 84 | 239 |
| Number Of Female Beneficiaries | 1172 |
| Number Of Male Beneficiaries | 598 |
| Number Of Non Hispanic White Beneficiaries | 1633 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 105 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1414 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 356 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 32 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0575 |