| National Provider Identifier [NPI]: | 1225150014 |
| Last Name Of The Provider | SONG |
| First Name Of The Provider | SAMUEL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 101 THE CITY DR S |
| Street Address 2 Of The Provider | BUILDING 56, SUITE 300 |
| City Of The Provider | ORANGE |
| Zip Code Of The Provider | 928683201 |
| 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 | 167 |
| Number Of Services | 4785 |
| Number Of Medicare Beneficiaries | 2509 |
| Total Submitted Charge Amount | 829085.18 |
| Total Medicare Allowed Amount | 209163.89 |
| Total Medicare Payment Amount | 157057.85 |
| Total Medicare Standardized Payment Amount | 152761.94 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 161 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 5264 |
| Total Drug Medicare AllowedAmount | 133.49 |
| Total Drug Medicare PaymentAmount | 104.69 |
| Total Drug Medicare Standardized Payment Amount | 104.69 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 165 |
| Number Of Medical Services | 4624 |
| Number Of Medicare Beneficiaries With Medical Services | 2509 |
| Total Medical Submitted Charge Amount | 823821.18 |
| Total Medical Medicare Allowed Amount | 209030.4 |
| Total Medical Medicare Payment Amount | 156953.16 |
| Total Medical Medicare Standardized Payment Amount | 152657.25 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 488 |
| Number Of Beneficiaries Age 65 to 74 | 825 |
| Number Of Beneficiaries Age 75 to 84 | 776 |
| Number Of Beneficiaries Age Greater 84 | 420 |
| Number Of Female Beneficiaries | 1264 |
| Number Of Male Beneficiaries | 1245 |
| Number Of Non Hispanic White Beneficiaries | 1787 |
| Number Of Black or African American Beneficiaries | 135 |
| Number Of AsianPacific Islander Beneficiaries | 102 |
| Number Of Hispanic Beneficiaries | 433 |
| Number Of American Indian Alaska Native Beneficiaries | 16 |
| Number Of Beneficiaries With Race Not Else where Classified | 36 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1527 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 982 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 1.9943 |