| National Provider Identifier [NPI]: | 1003064999 |
| Last Name Of The Provider | LARSON |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2020 PALOMINO LN |
| Street Address 2 Of The Provider | #100 |
| City Of The Provider | LAS VEGAS |
| Zip Code Of The Provider | 891064842 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 195 |
| Number Of Services | 17006 |
| Number Of Medicare Beneficiaries | 1718 |
| Total Submitted Charge Amount | 1053396.03 |
| Total Medicare Allowed Amount | 250189.18 |
| Total Medicare Payment Amount | 194332.05 |
| Total Medicare Standardized Payment Amount | 193253.47 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 14675 |
| Number Of Medicare Beneficiaries With Drug Services | 156 |
| Total Drug Submitted ChargeAmount | 45679.93 |
| Total Drug Medicare AllowedAmount | 3885.3 |
| Total Drug Medicare PaymentAmount | 3046.2 |
| Total Drug Medicare Standardized Payment Amount | 3046.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 190 |
| Number Of Medical Services | 2331 |
| Number Of Medicare Beneficiaries With Medical Services | 1718 |
| Total Medical Submitted Charge Amount | 1007716.1 |
| Total Medical Medicare Allowed Amount | 246303.88 |
| Total Medical Medicare Payment Amount | 191285.85 |
| Total Medical Medicare Standardized Payment Amount | 190207.27 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 323 |
| Number Of Beneficiaries Age 65 to 74 | 720 |
| Number Of Beneficiaries Age 75 to 84 | 496 |
| Number Of Beneficiaries Age Greater 84 | 179 |
| Number Of Female Beneficiaries | 959 |
| Number Of Male Beneficiaries | 759 |
| Number Of Non Hispanic White Beneficiaries | 1185 |
| Number Of Black or African American Beneficiaries | 240 |
| Number Of AsianPacific Islander Beneficiaries | 85 |
| Number Of Hispanic Beneficiaries | 164 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1316 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 402 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.6979 |