| National Provider Identifier [NPI]: | 1083854343 |
| Last Name Of The Provider | BEAUDOIN |
| First Name Of The Provider | AVA |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1601 WATSON BLVD |
| Street Address 2 Of The Provider | ATTN: RADIOLOGY DEPARTMENT |
| City Of The Provider | WARNER ROBINS |
| Zip Code Of The Provider | 310933431 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 143 |
| Number Of Services | 9399 |
| Number Of Medicare Beneficiaries | 4891 |
| Total Submitted Charge Amount | 863893 |
| Total Medicare Allowed Amount | 198937.26 |
| Total Medicare Payment Amount | 164078.18 |
| Total Medicare Standardized Payment Amount | 170853.91 |
| 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 | 143 |
| Number Of Medical Services | 9399 |
| Number Of Medicare Beneficiaries With Medical Services | 4891 |
| Total Medical Submitted Charge Amount | 863893 |
| Total Medical Medicare Allowed Amount | 198937.26 |
| Total Medical Medicare Payment Amount | 164078.18 |
| Total Medical Medicare Standardized Payment Amount | 170853.91 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 848 |
| Number Of Beneficiaries Age 65 to 74 | 2093 |
| Number Of Beneficiaries Age 75 to 84 | 1452 |
| Number Of Beneficiaries Age Greater 84 | 498 |
| Number Of Female Beneficiaries | 3591 |
| Number Of Male Beneficiaries | 1300 |
| Number Of Non Hispanic White Beneficiaries | 3575 |
| Number Of Black or African American Beneficiaries | 1161 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 51 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 53 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3945 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 946 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4145 |