| National Provider Identifier [NPI]: | 1386624435 |
| Last Name Of The Provider | LE |
| First Name Of The Provider | VAN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4111 S DARLINGTON AVE |
| Street Address 2 Of The Provider | STE 700 |
| City Of The Provider | TULSA |
| Zip Code Of The Provider | 741356348 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 190 |
| Number Of Services | 4821 |
| Number Of Medicare Beneficiaries | 3391 |
| Total Submitted Charge Amount | 426317.5 |
| Total Medicare Allowed Amount | 142311.42 |
| Total Medicare Payment Amount | 108576.78 |
| Total Medicare Standardized Payment Amount | 114906.34 |
| 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 | 4821 |
| Number Of Medicare Beneficiaries With Medical Services | 3391 |
| Total Medical Submitted Charge Amount | 426317.5 |
| Total Medical Medicare Allowed Amount | 142311.42 |
| Total Medical Medicare Payment Amount | 108576.78 |
| Total Medical Medicare Standardized Payment Amount | 114906.34 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 630 |
| Number Of Beneficiaries Age 65 to 74 | 1342 |
| Number Of Beneficiaries Age 75 to 84 | 937 |
| Number Of Beneficiaries Age Greater 84 | 482 |
| Number Of Female Beneficiaries | 2047 |
| Number Of Male Beneficiaries | 1344 |
| Number Of Non Hispanic White Beneficiaries | 2827 |
| Number Of Black or African American Beneficiaries | 201 |
| Number Of AsianPacific Islander Beneficiaries | 24 |
| Number Of Hispanic Beneficiaries | 41 |
| Number Of American Indian Alaska Native Beneficiaries | 270 |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2682 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 709 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.6479 |