| National Provider Identifier [NPI]: | 1598746232 |
| Last Name Of The Provider | SONG |
| First Name Of The Provider | JOON |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1304 FAWCETT AVE |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | TACOMA |
| Zip Code Of The Provider | 984021911 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 119 |
| Number Of Services | 8272 |
| Number Of Medicare Beneficiaries | 3163 |
| Total Submitted Charge Amount | 1295991 |
| Total Medicare Allowed Amount | 311033.12 |
| Total Medicare Payment Amount | 232683.88 |
| Total Medicare Standardized Payment Amount | 237422.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 3710 |
| Number Of Medicare Beneficiaries With Drug Services | 147 |
| Total Drug Submitted ChargeAmount | 19972.5 |
| Total Drug Medicare AllowedAmount | 4343.37 |
| Total Drug Medicare PaymentAmount | 3310.75 |
| Total Drug Medicare Standardized Payment Amount | 3310.75 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 116 |
| Number Of Medical Services | 4562 |
| Number Of Medicare Beneficiaries With Medical Services | 3161 |
| Total Medical Submitted Charge Amount | 1276018.5 |
| Total Medical Medicare Allowed Amount | 306689.75 |
| Total Medical Medicare Payment Amount | 229373.13 |
| Total Medical Medicare Standardized Payment Amount | 234112.07 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 580 |
| Number Of Beneficiaries Age 65 to 74 | 1116 |
| Number Of Beneficiaries Age 75 to 84 | 918 |
| Number Of Beneficiaries Age Greater 84 | 549 |
| Number Of Female Beneficiaries | 1840 |
| Number Of Male Beneficiaries | 1323 |
| Number Of Non Hispanic White Beneficiaries | 2550 |
| Number Of Black or African American Beneficiaries | 216 |
| Number Of AsianPacific Islander Beneficiaries | 205 |
| Number Of Hispanic Beneficiaries | 79 |
| Number Of American Indian Alaska Native Beneficiaries | 40 |
| Number Of Beneficiaries With Race Not Else where Classified | 73 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2285 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 878 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 18 |
| Average HCC Risk Score Of Beneficiaries | 1.653 |