| National Provider Identifier [NPI]: | 1073504742 |
| Last Name Of The Provider | JEAN |
| First Name Of The Provider | ALAN |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4102 RICHMOND MDWS |
| Street Address 2 Of The Provider | |
| City Of The Provider | TEXARKANA |
| Zip Code Of The Provider | 755030067 |
| 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 | 212 |
| Number Of Services | 9846 |
| Number Of Medicare Beneficiaries | 5401 |
| Total Submitted Charge Amount | 754134 |
| Total Medicare Allowed Amount | 241621.93 |
| Total Medicare Payment Amount | 190551.95 |
| Total Medicare Standardized Payment Amount | 200752.7 |
| 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 | 212 |
| Number Of Medical Services | 9846 |
| Number Of Medicare Beneficiaries With Medical Services | 5401 |
| Total Medical Submitted Charge Amount | 754134 |
| Total Medical Medicare Allowed Amount | 241621.93 |
| Total Medical Medicare Payment Amount | 190551.95 |
| Total Medical Medicare Standardized Payment Amount | 200752.7 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 1123 |
| Number Of Beneficiaries Age 65 to 74 | 1975 |
| Number Of Beneficiaries Age 75 to 84 | 1493 |
| Number Of Beneficiaries Age Greater 84 | 810 |
| Number Of Female Beneficiaries | 3403 |
| Number Of Male Beneficiaries | 1998 |
| Number Of Non Hispanic White Beneficiaries | 4202 |
| Number Of Black or African American Beneficiaries | 1074 |
| Number Of AsianPacific Islander Beneficiaries | 13 |
| Number Of Hispanic Beneficiaries | 54 |
| Number Of American Indian Alaska Native Beneficiaries | 43 |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3714 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1687 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.5852 |