| National Provider Identifier [NPI]: | 1891796660 |
| Last Name Of The Provider | SOLIVAN |
| First Name Of The Provider | LUIS |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4445 MAGNOLIA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | RIVERSIDE |
| Zip Code Of The Provider | 925014135 |
| 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 | 60 |
| Number Of Services | 5020 |
| Number Of Medicare Beneficiaries | 2213 |
| Total Submitted Charge Amount | 819279.95 |
| Total Medicare Allowed Amount | 404294.47 |
| Total Medicare Payment Amount | 357578.58 |
| Total Medicare Standardized Payment Amount | 336767.7 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 657 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 1470 |
| Total Drug Medicare AllowedAmount | 261.11 |
| Total Drug Medicare PaymentAmount | 204.71 |
| Total Drug Medicare Standardized Payment Amount | 204.71 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 57 |
| Number Of Medical Services | 4363 |
| Number Of Medicare Beneficiaries With Medical Services | 2213 |
| Total Medical Submitted Charge Amount | 817809.95 |
| Total Medical Medicare Allowed Amount | 404033.36 |
| Total Medical Medicare Payment Amount | 357373.87 |
| Total Medical Medicare Standardized Payment Amount | 336562.99 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 399 |
| Number Of Beneficiaries Age 65 to 74 | 1124 |
| Number Of Beneficiaries Age 75 to 84 | 557 |
| Number Of Beneficiaries Age Greater 84 | 133 |
| Number Of Female Beneficiaries | 2008 |
| Number Of Male Beneficiaries | 205 |
| Number Of Non Hispanic White Beneficiaries | 1378 |
| Number Of Black or African American Beneficiaries | 270 |
| Number Of AsianPacific Islander Beneficiaries | 65 |
| Number Of Hispanic Beneficiaries | 454 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1470 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 743 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2345 |