| National Provider Identifier [NPI]: | 1194863902 |
| Last Name Of The Provider | LUBISICH |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 501 WASHINGTON ST |
| Street Address 2 Of The Provider | STE 510 |
| City Of The Provider | SAN DIEGO |
| Zip Code Of The Provider | 921032231 |
| 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 | 216 |
| Number Of Services | 8440 |
| Number Of Medicare Beneficiaries | 2079 |
| Total Submitted Charge Amount | 859527.21 |
| Total Medicare Allowed Amount | 207174.69 |
| Total Medicare Payment Amount | 159061.4 |
| Total Medicare Standardized Payment Amount | 153771.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 4493 |
| Number Of Medicare Beneficiaries With Drug Services | 48 |
| Total Drug Submitted ChargeAmount | 9016 |
| Total Drug Medicare AllowedAmount | 779.78 |
| Total Drug Medicare PaymentAmount | 611.29 |
| Total Drug Medicare Standardized Payment Amount | 611.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 214 |
| Number Of Medical Services | 3947 |
| Number Of Medicare Beneficiaries With Medical Services | 2079 |
| Total Medical Submitted Charge Amount | 850511.21 |
| Total Medical Medicare Allowed Amount | 206394.91 |
| Total Medical Medicare Payment Amount | 158450.11 |
| Total Medical Medicare Standardized Payment Amount | 153160.68 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 425 |
| Number Of Beneficiaries Age 65 to 74 | 749 |
| Number Of Beneficiaries Age 75 to 84 | 560 |
| Number Of Beneficiaries Age Greater 84 | 345 |
| Number Of Female Beneficiaries | 1233 |
| Number Of Male Beneficiaries | 846 |
| Number Of Non Hispanic White Beneficiaries | 1340 |
| Number Of Black or African American Beneficiaries | 179 |
| Number Of AsianPacific Islander Beneficiaries | 181 |
| Number Of Hispanic Beneficiaries | 336 |
| Number Of American Indian Alaska Native Beneficiaries | 14 |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1029 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1050 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 18 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.0253 |