| National Provider Identifier [NPI]: | 1871584227 |
| Last Name Of The Provider | WONG |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 525 W ACACIA ST |
| Street Address 2 Of The Provider | RADIOLOGY |
| City Of The Provider | STOCKTON |
| Zip Code Of The Provider | 952032405 |
| 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 | 155 |
| Number Of Services | 5272 |
| Number Of Medicare Beneficiaries | 1953 |
| Total Submitted Charge Amount | 405122 |
| Total Medicare Allowed Amount | 153839.54 |
| Total Medicare Payment Amount | 117616.73 |
| Total Medicare Standardized Payment Amount | 116624.31 |
| 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 | 155 |
| Number Of Medical Services | 5272 |
| Number Of Medicare Beneficiaries With Medical Services | 1953 |
| Total Medical Submitted Charge Amount | 405122 |
| Total Medical Medicare Allowed Amount | 153839.54 |
| Total Medical Medicare Payment Amount | 117616.73 |
| Total Medical Medicare Standardized Payment Amount | 116624.31 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 531 |
| Number Of Beneficiaries Age 65 to 74 | 662 |
| Number Of Beneficiaries Age 75 to 84 | 450 |
| Number Of Beneficiaries Age Greater 84 | 310 |
| Number Of Female Beneficiaries | 1099 |
| Number Of Male Beneficiaries | 854 |
| Number Of Non Hispanic White Beneficiaries | 960 |
| Number Of Black or African American Beneficiaries | 330 |
| Number Of AsianPacific Islander Beneficiaries | 224 |
| Number Of Hispanic Beneficiaries | 399 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 855 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1098 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.9265 |