| National Provider Identifier [NPI]: | 1639374374 |
| Last Name Of The Provider | CHURCH |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8401 DATAPOINT DR |
| Street Address 2 Of The Provider | SUITE 600 |
| City Of The Provider | SAN ANTONIO |
| Zip Code Of The Provider | 782295900 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 167 |
| Number Of Services | 14922 |
| Number Of Medicare Beneficiaries | 3938 |
| Total Submitted Charge Amount | 789205.84 |
| Total Medicare Allowed Amount | 244246.4 |
| Total Medicare Payment Amount | 198481.67 |
| Total Medicare Standardized Payment Amount | 213150.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 9205 |
| Number Of Medicare Beneficiaries With Drug Services | 97 |
| Total Drug Submitted ChargeAmount | 5335 |
| Total Drug Medicare AllowedAmount | 2178.7 |
| Total Drug Medicare PaymentAmount | 1694.15 |
| Total Drug Medicare Standardized Payment Amount | 1694.15 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 164 |
| Number Of Medical Services | 5717 |
| Number Of Medicare Beneficiaries With Medical Services | 3938 |
| Total Medical Submitted Charge Amount | 783870.84 |
| Total Medical Medicare Allowed Amount | 242067.7 |
| Total Medical Medicare Payment Amount | 196787.52 |
| Total Medical Medicare Standardized Payment Amount | 211456.58 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 719 |
| Number Of Beneficiaries Age 65 to 74 | 1482 |
| Number Of Beneficiaries Age 75 to 84 | 1106 |
| Number Of Beneficiaries Age Greater 84 | 631 |
| Number Of Female Beneficiaries | 2515 |
| Number Of Male Beneficiaries | 1423 |
| Number Of Non Hispanic White Beneficiaries | 2287 |
| Number Of Black or African American Beneficiaries | 226 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 1341 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 42 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2852 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1086 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.0746 |