| National Provider Identifier [NPI]: | 1619047891 |
| Last Name Of The Provider | VERNACCHIA |
| First Name Of The Provider | FRED |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1100 MONTEREY ST |
| Street Address 2 Of The Provider | SUITE 210 |
| City Of The Provider | SAN LUIS OBISPO |
| Zip Code Of The Provider | 934013102 |
| 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 | 198 |
| Number Of Services | 55588 |
| Number Of Medicare Beneficiaries | 2065 |
| Total Submitted Charge Amount | 3269742 |
| Total Medicare Allowed Amount | 1062109.78 |
| Total Medicare Payment Amount | 831473.33 |
| Total Medicare Standardized Payment Amount | 798630.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 50481 |
| Number Of Medicare Beneficiaries With Drug Services | 567 |
| Total Drug Submitted ChargeAmount | 126817 |
| Total Drug Medicare AllowedAmount | 16392.32 |
| Total Drug Medicare PaymentAmount | 12788.03 |
| Total Drug Medicare Standardized Payment Amount | 12788.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 192 |
| Number Of Medical Services | 5107 |
| Number Of Medicare Beneficiaries With Medical Services | 2065 |
| Total Medical Submitted Charge Amount | 3142925 |
| Total Medical Medicare Allowed Amount | 1045717.46 |
| Total Medical Medicare Payment Amount | 818685.3 |
| Total Medical Medicare Standardized Payment Amount | 785842.79 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 168 |
| Number Of Beneficiaries Age 65 to 74 | 1160 |
| Number Of Beneficiaries Age 75 to 84 | 552 |
| Number Of Beneficiaries Age Greater 84 | 185 |
| Number Of Female Beneficiaries | 1417 |
| Number Of Male Beneficiaries | 648 |
| Number Of Non Hispanic White Beneficiaries | 1916 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 74 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 35 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1888 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 177 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 49 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.9242 |