| National Provider Identifier [NPI]: | 1386683209 |
| Last Name Of The Provider | AMEZAGA |
| First Name Of The Provider | JESSE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1535 GULL RD |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | KALAMAZOO |
| Zip Code Of The Provider | 490481650 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 160 |
| Number Of Services | 6112 |
| Number Of Medicare Beneficiaries | 3890 |
| Total Submitted Charge Amount | 475767 |
| Total Medicare Allowed Amount | 179033.21 |
| Total Medicare Payment Amount | 139669.21 |
| Total Medicare Standardized Payment Amount | 138908.38 |
| 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 | 160 |
| Number Of Medical Services | 6112 |
| Number Of Medicare Beneficiaries With Medical Services | 3890 |
| Total Medical Submitted Charge Amount | 475767 |
| Total Medical Medicare Allowed Amount | 179033.21 |
| Total Medical Medicare Payment Amount | 139669.21 |
| Total Medical Medicare Standardized Payment Amount | 138908.38 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 1047 |
| Number Of Beneficiaries Age 65 to 74 | 1232 |
| Number Of Beneficiaries Age 75 to 84 | 948 |
| Number Of Beneficiaries Age Greater 84 | 663 |
| Number Of Female Beneficiaries | 2532 |
| Number Of Male Beneficiaries | 1358 |
| Number Of Non Hispanic White Beneficiaries | 3212 |
| Number Of Black or African American Beneficiaries | 480 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 107 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 55 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2647 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1243 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 42 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.0377 |