| National Provider Identifier [NPI]: | 1215937974 |
| Last Name Of The Provider | MOMII |
| First Name Of The Provider | GEORGE |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6925 N. DURANGO DRIVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAS VEGAS |
| Zip Code Of The Provider | 89149 |
| 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 | 213 |
| Number Of Services | 23559 |
| Number Of Medicare Beneficiaries | 2292 |
| Total Submitted Charge Amount | 2019917.34 |
| Total Medicare Allowed Amount | 778966.5 |
| Total Medicare Payment Amount | 576551.74 |
| Total Medicare Standardized Payment Amount | 585202.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 20056 |
| Number Of Medicare Beneficiaries With Drug Services | 531 |
| Total Drug Submitted ChargeAmount | 16922.62 |
| Total Drug Medicare AllowedAmount | 11315.29 |
| Total Drug Medicare PaymentAmount | 8498.33 |
| Total Drug Medicare Standardized Payment Amount | 8498.33 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 204 |
| Number Of Medical Services | 3503 |
| Number Of Medicare Beneficiaries With Medical Services | 2292 |
| Total Medical Submitted Charge Amount | 2002994.72 |
| Total Medical Medicare Allowed Amount | 767651.21 |
| Total Medical Medicare Payment Amount | 568053.41 |
| Total Medical Medicare Standardized Payment Amount | 576704.48 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 326 |
| Number Of Beneficiaries Age 65 to 74 | 1187 |
| Number Of Beneficiaries Age 75 to 84 | 620 |
| Number Of Beneficiaries Age Greater 84 | 159 |
| Number Of Female Beneficiaries | 1420 |
| Number Of Male Beneficiaries | 872 |
| Number Of Non Hispanic White Beneficiaries | 1678 |
| Number Of Black or African American Beneficiaries | 229 |
| Number Of AsianPacific Islander Beneficiaries | 140 |
| Number Of Hispanic Beneficiaries | 186 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1988 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 304 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3643 |