| National Provider Identifier [NPI]: | 1578773032 |
| Last Name Of The Provider | HARRIS |
| First Name Of The Provider | BRENTON |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1948 1ST AVENUE NE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CEDAR RAPIDS |
| Zip Code Of The Provider | 524025342 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 180 |
| Number Of Services | 6851 |
| Number Of Medicare Beneficiaries | 4806 |
| Total Submitted Charge Amount | 754283.94 |
| Total Medicare Allowed Amount | 213981.71 |
| Total Medicare Payment Amount | 163153.71 |
| Total Medicare Standardized Payment Amount | 174271.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 252 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 729 |
| Total Drug Medicare AllowedAmount | 317.26 |
| Total Drug Medicare PaymentAmount | 217.85 |
| Total Drug Medicare Standardized Payment Amount | 217.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 178 |
| Number Of Medical Services | 6599 |
| Number Of Medicare Beneficiaries With Medical Services | 4806 |
| Total Medical Submitted Charge Amount | 753554.94 |
| Total Medical Medicare Allowed Amount | 213664.45 |
| Total Medical Medicare Payment Amount | 162935.86 |
| Total Medical Medicare Standardized Payment Amount | 174053.42 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 815 |
| Number Of Beneficiaries Age 65 to 74 | 1585 |
| Number Of Beneficiaries Age 75 to 84 | 1426 |
| Number Of Beneficiaries Age Greater 84 | 980 |
| Number Of Female Beneficiaries | 2935 |
| Number Of Male Beneficiaries | 1871 |
| Number Of Non Hispanic White Beneficiaries | 4649 |
| Number Of Black or African American Beneficiaries | 87 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 21 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 36 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3663 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1143 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.3596 |