| National Provider Identifier [NPI]: | 1548259526 |
| Last Name Of The Provider | JORGENSEN |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3501 N SCOTTSDALE RD |
| Street Address 2 Of The Provider | STE 130 |
| City Of The Provider | SCOTTSDALE |
| Zip Code Of The Provider | 852515648 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 263 |
| Number Of Services | 11325 |
| Number Of Medicare Beneficiaries | 4947 |
| Total Submitted Charge Amount | 1138015.6 |
| Total Medicare Allowed Amount | 271273.18 |
| Total Medicare Payment Amount | 199936.38 |
| Total Medicare Standardized Payment Amount | 204682.21 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 2866 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 7761.6 |
| Total Drug Medicare AllowedAmount | 535.03 |
| Total Drug Medicare PaymentAmount | 419.39 |
| Total Drug Medicare Standardized Payment Amount | 419.39 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 261 |
| Number Of Medical Services | 8459 |
| Number Of Medicare Beneficiaries With Medical Services | 4947 |
| Total Medical Submitted Charge Amount | 1130254 |
| Total Medical Medicare Allowed Amount | 270738.15 |
| Total Medical Medicare Payment Amount | 199516.99 |
| Total Medical Medicare Standardized Payment Amount | 204262.82 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 352 |
| Number Of Beneficiaries Age 65 to 74 | 2074 |
| Number Of Beneficiaries Age 75 to 84 | 1525 |
| Number Of Beneficiaries Age Greater 84 | 996 |
| Number Of Female Beneficiaries | 2708 |
| Number Of Male Beneficiaries | 2239 |
| Number Of Non Hispanic White Beneficiaries | 4574 |
| Number Of Black or African American Beneficiaries | 74 |
| Number Of AsianPacific Islander Beneficiaries | 37 |
| Number Of Hispanic Beneficiaries | 123 |
| Number Of American Indian Alaska Native Beneficiaries | 65 |
| Number Of Beneficiaries With Race Not Else where Classified | 74 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4584 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 363 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5103 |