| National Provider Identifier [NPI]: | 1396740338 |
| Last Name Of The Provider | HALT |
| First Name Of The Provider | PETER |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 914 PINE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MOUNT SHASTA |
| Zip Code Of The Provider | 960672143 |
| 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 | 190 |
| Number Of Services | 6395 |
| Number Of Medicare Beneficiaries | 2996 |
| Total Submitted Charge Amount | 774280.48 |
| Total Medicare Allowed Amount | 174912.74 |
| Total Medicare Payment Amount | 125295.93 |
| Total Medicare Standardized Payment Amount | 124287.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 190 |
| Number Of Medical Services | 6395 |
| Number Of Medicare Beneficiaries With Medical Services | 2996 |
| Total Medical Submitted Charge Amount | 774280.48 |
| Total Medical Medicare Allowed Amount | 174912.74 |
| Total Medical Medicare Payment Amount | 125295.93 |
| Total Medical Medicare Standardized Payment Amount | 124287.67 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 595 |
| Number Of Beneficiaries Age 65 to 74 | 1207 |
| Number Of Beneficiaries Age 75 to 84 | 815 |
| Number Of Beneficiaries Age Greater 84 | 379 |
| Number Of Female Beneficiaries | 1781 |
| Number Of Male Beneficiaries | 1215 |
| Number Of Non Hispanic White Beneficiaries | 2683 |
| Number Of Black or African American Beneficiaries | 31 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 122 |
| Number Of American Indian Alaska Native Beneficiaries | 129 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2060 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 936 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0974 |