| National Provider Identifier [NPI]: | 1477520930 |
| Last Name Of The Provider | MEDINA |
| First Name Of The Provider | JORGE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 222 15TH AVE SE |
| Street Address 2 Of The Provider | |
| City Of The Provider | PUYALLUP |
| Zip Code Of The Provider | 983723754 |
| 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 | 135 |
| Number Of Services | 20260 |
| Number Of Medicare Beneficiaries | 2174 |
| Total Submitted Charge Amount | 777735 |
| Total Medicare Allowed Amount | 219761.78 |
| Total Medicare Payment Amount | 166496.22 |
| Total Medicare Standardized Payment Amount | 167623.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 17036 |
| Number Of Medicare Beneficiaries With Drug Services | 199 |
| Total Drug Submitted ChargeAmount | 34210 |
| Total Drug Medicare AllowedAmount | 3808.99 |
| Total Drug Medicare PaymentAmount | 2963.88 |
| Total Drug Medicare Standardized Payment Amount | 2963.88 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 131 |
| Number Of Medical Services | 3224 |
| Number Of Medicare Beneficiaries With Medical Services | 2174 |
| Total Medical Submitted Charge Amount | 743525 |
| Total Medical Medicare Allowed Amount | 215952.79 |
| Total Medical Medicare Payment Amount | 163532.34 |
| Total Medical Medicare Standardized Payment Amount | 164659.3 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 322 |
| Number Of Beneficiaries Age 65 to 74 | 762 |
| Number Of Beneficiaries Age 75 to 84 | 694 |
| Number Of Beneficiaries Age Greater 84 | 396 |
| Number Of Female Beneficiaries | 1253 |
| Number Of Male Beneficiaries | 921 |
| Number Of Non Hispanic White Beneficiaries | 1981 |
| Number Of Black or African American Beneficiaries | 44 |
| Number Of AsianPacific Islander Beneficiaries | 43 |
| Number Of Hispanic Beneficiaries | 55 |
| Number Of American Indian Alaska Native Beneficiaries | 26 |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1758 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 416 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.8644 |