| National Provider Identifier [NPI]: | 1861447898 |
| Last Name Of The Provider | SAM |
| First Name Of The Provider | JOSEPH |
| Middle Initial Of The Provider | W |
| 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 | 132 |
| Number Of Services | 7163 |
| Number Of Medicare Beneficiaries | 2494 |
| Total Submitted Charge Amount | 1676530.49 |
| Total Medicare Allowed Amount | 529635.54 |
| Total Medicare Payment Amount | 407992.81 |
| Total Medicare Standardized Payment Amount | 412379.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 3248 |
| Number Of Medicare Beneficiaries With Drug Services | 61 |
| Total Drug Submitted ChargeAmount | 2190.48 |
| Total Drug Medicare AllowedAmount | 1131.46 |
| Total Drug Medicare PaymentAmount | 808.51 |
| Total Drug Medicare Standardized Payment Amount | 808.51 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 129 |
| Number Of Medical Services | 3915 |
| Number Of Medicare Beneficiaries With Medical Services | 2493 |
| Total Medical Submitted Charge Amount | 1674340.01 |
| Total Medical Medicare Allowed Amount | 528504.08 |
| Total Medical Medicare Payment Amount | 407184.3 |
| Total Medical Medicare Standardized Payment Amount | 411571.35 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 487 |
| Number Of Beneficiaries Age 65 to 74 | 874 |
| Number Of Beneficiaries Age 75 to 84 | 763 |
| Number Of Beneficiaries Age Greater 84 | 370 |
| Number Of Female Beneficiaries | 1399 |
| Number Of Male Beneficiaries | 1095 |
| Number Of Non Hispanic White Beneficiaries | 2008 |
| Number Of Black or African American Beneficiaries | 177 |
| Number Of AsianPacific Islander Beneficiaries | 154 |
| Number Of Hispanic Beneficiaries | 70 |
| Number Of American Indian Alaska Native Beneficiaries | 50 |
| Number Of Beneficiaries With Race Not Else where Classified | 35 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1786 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 708 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 28 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.9191 |