| National Provider Identifier [NPI]: | 1104073709 |
| Last Name Of The Provider | LARSEN |
| First Name Of The Provider | GREGORY |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 400 N PEPPER AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | COLTON |
| Zip Code Of The Provider | 923241801 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 75 |
| Number Of Services | 1106 |
| Number Of Medicare Beneficiaries | 609 |
| Total Submitted Charge Amount | 381452 |
| Total Medicare Allowed Amount | 100518.65 |
| Total Medicare Payment Amount | 77429.68 |
| Total Medicare Standardized Payment Amount | 75118.91 |
| 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 | 75 |
| Number Of Medical Services | 1106 |
| Number Of Medicare Beneficiaries With Medical Services | 609 |
| Total Medical Submitted Charge Amount | 381452 |
| Total Medical Medicare Allowed Amount | 100518.65 |
| Total Medical Medicare Payment Amount | 77429.68 |
| Total Medical Medicare Standardized Payment Amount | 75118.91 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 173 |
| Number Of Beneficiaries Age 65 to 74 | 184 |
| Number Of Beneficiaries Age 75 to 84 | 148 |
| Number Of Beneficiaries Age Greater 84 | 104 |
| Number Of Female Beneficiaries | 353 |
| Number Of Male Beneficiaries | 256 |
| Number Of Non Hispanic White Beneficiaries | 387 |
| Number Of Black or African American Beneficiaries | 109 |
| Number Of AsianPacific Islander Beneficiaries | 34 |
| Number Of Hispanic Beneficiaries | 58 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 309 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 300 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.5283 |