| National Provider Identifier [NPI]: | 1538150933 |
| Last Name Of The Provider | HENRICKS |
| First Name Of The Provider | BRET |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M. D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1305 LAKELAND HILLS BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAKELAND |
| Zip Code Of The Provider | 338054542 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 168 |
| Number Of Services | 5765 |
| Number Of Medicare Beneficiaries | 3268 |
| Total Submitted Charge Amount | 630448 |
| Total Medicare Allowed Amount | 172481.56 |
| Total Medicare Payment Amount | 130489.83 |
| Total Medicare Standardized Payment Amount | 132804.5 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 480 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 2043 |
| Total Drug Medicare AllowedAmount | 443.88 |
| Total Drug Medicare PaymentAmount | 347.99 |
| Total Drug Medicare Standardized Payment Amount | 347.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 164 |
| Number Of Medical Services | 5285 |
| Number Of Medicare Beneficiaries With Medical Services | 3268 |
| Total Medical Submitted Charge Amount | 628405 |
| Total Medical Medicare Allowed Amount | 172037.68 |
| Total Medical Medicare Payment Amount | 130141.84 |
| Total Medical Medicare Standardized Payment Amount | 132456.51 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 694 |
| Number Of Beneficiaries Age 65 to 74 | 1045 |
| Number Of Beneficiaries Age 75 to 84 | 948 |
| Number Of Beneficiaries Age Greater 84 | 581 |
| Number Of Female Beneficiaries | 1971 |
| Number Of Male Beneficiaries | 1297 |
| Number Of Non Hispanic White Beneficiaries | 2628 |
| Number Of Black or African American Beneficiaries | 405 |
| Number Of AsianPacific Islander Beneficiaries | 28 |
| Number Of Hispanic Beneficiaries | 187 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2090 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1178 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 25 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.1042 |