| National Provider Identifier [NPI]: | 1740445121 |
| Last Name Of The Provider | HENDERSON |
| First Name Of The Provider | PATRICK |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 410 DICKINSON ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAN DIEGO |
| Zip Code Of The Provider | 921036902 |
| 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 | 158 |
| Number Of Services | 2853 |
| Number Of Medicare Beneficiaries | 1776 |
| Total Submitted Charge Amount | 385958 |
| Total Medicare Allowed Amount | 86989.47 |
| Total Medicare Payment Amount | 66881.94 |
| Total Medicare Standardized Payment Amount | 70490.97 |
| 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 | 158 |
| Number Of Medical Services | 2853 |
| Number Of Medicare Beneficiaries With Medical Services | 1776 |
| Total Medical Submitted Charge Amount | 385958 |
| Total Medical Medicare Allowed Amount | 86989.47 |
| Total Medical Medicare Payment Amount | 66881.94 |
| Total Medical Medicare Standardized Payment Amount | 70490.97 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 477 |
| Number Of Beneficiaries Age 65 to 74 | 617 |
| Number Of Beneficiaries Age 75 to 84 | 498 |
| Number Of Beneficiaries Age Greater 84 | 184 |
| Number Of Female Beneficiaries | 1086 |
| Number Of Male Beneficiaries | 690 |
| Number Of Non Hispanic White Beneficiaries | 1550 |
| Number Of Black or African American Beneficiaries | 69 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 121 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1104 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 672 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.6407 |