| National Provider Identifier [NPI]: | 1467423913 |
| Last Name Of The Provider | BOUDREAUX |
| First Name Of The Provider | BRENT |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2600 GREENWOOD RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SHREVEPORT |
| Zip Code Of The Provider | 711033908 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 265 |
| Number Of Services | 9436 |
| Number Of Medicare Beneficiaries | 5358 |
| Total Submitted Charge Amount | 1163521 |
| Total Medicare Allowed Amount | 281761.35 |
| Total Medicare Payment Amount | 211281.94 |
| Total Medicare Standardized Payment Amount | 220643.25 |
| 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 | 265 |
| Number Of Medical Services | 9436 |
| Number Of Medicare Beneficiaries With Medical Services | 5358 |
| Total Medical Submitted Charge Amount | 1163521 |
| Total Medical Medicare Allowed Amount | 281761.35 |
| Total Medical Medicare Payment Amount | 211281.94 |
| Total Medical Medicare Standardized Payment Amount | 220643.25 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 1071 |
| Number Of Beneficiaries Age 65 to 74 | 1884 |
| Number Of Beneficiaries Age 75 to 84 | 1611 |
| Number Of Beneficiaries Age Greater 84 | 792 |
| Number Of Female Beneficiaries | 3296 |
| Number Of Male Beneficiaries | 2062 |
| Number Of Non Hispanic White Beneficiaries | 3679 |
| Number Of Black or African American Beneficiaries | 1554 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 53 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 40 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3687 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1671 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.04 |