| National Provider Identifier [NPI]: | 1023050341 |
| Last Name Of The Provider | MAINWARING |
| First Name Of The Provider | BRENT |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3405 COLLEGE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BEAUMONT |
| Zip Code Of The Provider | 777014613 |
| 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 | 146 |
| Number Of Services | 2174 |
| Number Of Medicare Beneficiaries | 1205 |
| Total Submitted Charge Amount | 1409915 |
| Total Medicare Allowed Amount | 292835.3 |
| Total Medicare Payment Amount | 227154.45 |
| Total Medicare Standardized Payment Amount | 250205.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 81 |
| Number Of Medicare Beneficiaries With Drug Services | 80 |
| Total Drug Submitted ChargeAmount | 41310 |
| Total Drug Medicare AllowedAmount | 13.98 |
| Total Drug Medicare PaymentAmount | 11.49 |
| Total Drug Medicare Standardized Payment Amount | 11.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 145 |
| Number Of Medical Services | 2093 |
| Number Of Medicare Beneficiaries With Medical Services | 1205 |
| Total Medical Submitted Charge Amount | 1368605 |
| Total Medical Medicare Allowed Amount | 292821.32 |
| Total Medical Medicare Payment Amount | 227142.96 |
| Total Medical Medicare Standardized Payment Amount | 250193.63 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 201 |
| Number Of Beneficiaries Age 65 to 74 | 595 |
| Number Of Beneficiaries Age 75 to 84 | 312 |
| Number Of Beneficiaries Age Greater 84 | 97 |
| Number Of Female Beneficiaries | 788 |
| Number Of Male Beneficiaries | 417 |
| Number Of Non Hispanic White Beneficiaries | 1025 |
| Number Of Black or African American Beneficiaries | 142 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1037 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 168 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.1469 |