| National Provider Identifier [NPI]: | 1861478463 |
| Last Name Of The Provider | LERTVARANURAK |
| First Name Of The Provider | VARAVOOT |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 845 JACKSON ST |
| Street Address 2 Of The Provider | RADIOLOGY |
| City Of The Provider | SAN FRANCISCO |
| Zip Code Of The Provider | 941334851 |
| 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 | 123 |
| Number Of Services | 12330 |
| Number Of Medicare Beneficiaries | 595 |
| Total Submitted Charge Amount | 2392464.52 |
| Total Medicare Allowed Amount | 346093.22 |
| Total Medicare Payment Amount | 267413.06 |
| Total Medicare Standardized Payment Amount | 241406.85 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 11336 |
| Number Of Medicare Beneficiaries With Drug Services | 224 |
| Total Drug Submitted ChargeAmount | 75243.68 |
| Total Drug Medicare AllowedAmount | 4551.17 |
| Total Drug Medicare PaymentAmount | 3537.94 |
| Total Drug Medicare Standardized Payment Amount | 3537.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 120 |
| Number Of Medical Services | 994 |
| Number Of Medicare Beneficiaries With Medical Services | 594 |
| Total Medical Submitted Charge Amount | 2317220.84 |
| Total Medical Medicare Allowed Amount | 341542.05 |
| Total Medical Medicare Payment Amount | 263875.12 |
| Total Medical Medicare Standardized Payment Amount | 237868.91 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 211 |
| Number Of Beneficiaries Age 65 to 74 | 236 |
| Number Of Beneficiaries Age 75 to 84 | 112 |
| Number Of Beneficiaries Age Greater 84 | 36 |
| Number Of Female Beneficiaries | 368 |
| Number Of Male Beneficiaries | 227 |
| Number Of Non Hispanic White Beneficiaries | 392 |
| Number Of Black or African American Beneficiaries | 77 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 101 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 325 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 270 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 64 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3563 |