| National Provider Identifier [NPI]: | 1538155866 |
| Last Name Of The Provider | NELSON |
| First Name Of The Provider | ANTONIO |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 21 CROSSROADS DR |
| Street Address 2 Of The Provider | STE 100 |
| City Of The Provider | OWINGS MILLS |
| Zip Code Of The Provider | 211175441 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 102 |
| Number Of Services | 23829 |
| Number Of Medicare Beneficiaries | 1486 |
| Total Submitted Charge Amount | 1364774.91 |
| Total Medicare Allowed Amount | 292381.75 |
| Total Medicare Payment Amount | 214977.5 |
| Total Medicare Standardized Payment Amount | 215827.64 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 21295 |
| Number Of Medicare Beneficiaries With Drug Services | 218 |
| Total Drug Submitted ChargeAmount | 26726.75 |
| Total Drug Medicare AllowedAmount | 4010.66 |
| Total Drug Medicare PaymentAmount | 2875.94 |
| Total Drug Medicare Standardized Payment Amount | 2875.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 100 |
| Number Of Medical Services | 2534 |
| Number Of Medicare Beneficiaries With Medical Services | 1486 |
| Total Medical Submitted Charge Amount | 1338048.16 |
| Total Medical Medicare Allowed Amount | 288371.09 |
| Total Medical Medicare Payment Amount | 212101.56 |
| Total Medical Medicare Standardized Payment Amount | 212951.7 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 213 |
| Number Of Beneficiaries Age 65 to 74 | 678 |
| Number Of Beneficiaries Age 75 to 84 | 446 |
| Number Of Beneficiaries Age Greater 84 | 149 |
| Number Of Female Beneficiaries | 974 |
| Number Of Male Beneficiaries | 512 |
| Number Of Non Hispanic White Beneficiaries | 1232 |
| Number Of Black or African American Beneficiaries | 207 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 19 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1307 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 179 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2235 |