| National Provider Identifier [NPI]: | 1811955255 |
| Last Name Of The Provider | GOMEZ |
| First Name Of The Provider | LORI |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 19 WOODLAND ST |
| Street Address 2 Of The Provider | SUITE 15 |
| City Of The Provider | HARTFORD |
| Zip Code Of The Provider | 061052372 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 106 |
| Number Of Services | 11303 |
| Number Of Medicare Beneficiaries | 1440 |
| Total Submitted Charge Amount | 870854 |
| Total Medicare Allowed Amount | 247408.33 |
| Total Medicare Payment Amount | 193732.6 |
| Total Medicare Standardized Payment Amount | 176269.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 8922 |
| Number Of Medicare Beneficiaries With Drug Services | 95 |
| Total Drug Submitted ChargeAmount | 10125 |
| Total Drug Medicare AllowedAmount | 2406.51 |
| Total Drug Medicare PaymentAmount | 1869.49 |
| Total Drug Medicare Standardized Payment Amount | 1869.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 104 |
| Number Of Medical Services | 2381 |
| Number Of Medicare Beneficiaries With Medical Services | 1440 |
| Total Medical Submitted Charge Amount | 860729 |
| Total Medical Medicare Allowed Amount | 245001.82 |
| Total Medical Medicare Payment Amount | 191863.11 |
| Total Medical Medicare Standardized Payment Amount | 174400.02 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 193 |
| Number Of Beneficiaries Age 65 to 74 | 581 |
| Number Of Beneficiaries Age 75 to 84 | 458 |
| Number Of Beneficiaries Age Greater 84 | 208 |
| Number Of Female Beneficiaries | 940 |
| Number Of Male Beneficiaries | 500 |
| Number Of Non Hispanic White Beneficiaries | 771 |
| Number Of Black or African American Beneficiaries | 457 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 143 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 47 |
| Number Of Beneficiaries With Medicare Only Entitlement | 981 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 459 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.1416 |