| National Provider Identifier [NPI]: | 1578563987 |
| Last Name Of The Provider | HAVENER |
| First Name Of The Provider | ALLEN |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5002 COWHORN CREEK RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | TEXARKANA |
| Zip Code Of The Provider | 755039766 |
| 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 | 144 |
| Number Of Services | 51919 |
| Number Of Medicare Beneficiaries | 3488 |
| Total Submitted Charge Amount | 2358789.75 |
| Total Medicare Allowed Amount | 591990.18 |
| Total Medicare Payment Amount | 459416.84 |
| Total Medicare Standardized Payment Amount | 504708.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 46231 |
| Number Of Medicare Beneficiaries With Drug Services | 589 |
| Total Drug Submitted ChargeAmount | 148560 |
| Total Drug Medicare AllowedAmount | 16514.15 |
| Total Drug Medicare PaymentAmount | 12622.12 |
| Total Drug Medicare Standardized Payment Amount | 12622.12 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 137 |
| Number Of Medical Services | 5688 |
| Number Of Medicare Beneficiaries With Medical Services | 3488 |
| Total Medical Submitted Charge Amount | 2210229.75 |
| Total Medical Medicare Allowed Amount | 575476.03 |
| Total Medical Medicare Payment Amount | 446794.72 |
| Total Medical Medicare Standardized Payment Amount | 492085.96 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 393 |
| Number Of Beneficiaries Age 65 to 74 | 1618 |
| Number Of Beneficiaries Age 75 to 84 | 1109 |
| Number Of Beneficiaries Age Greater 84 | 368 |
| Number Of Female Beneficiaries | 2377 |
| Number Of Male Beneficiaries | 1111 |
| Number Of Non Hispanic White Beneficiaries | 2952 |
| Number Of Black or African American Beneficiaries | 475 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 22 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3072 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 416 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.165 |