| National Provider Identifier [NPI]: | 1487686713 |
| Last Name Of The Provider | COUGHLIN |
| First Name Of The Provider | BRET |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 111 FOUNDERS PLZ |
| Street Address 2 Of The Provider | STE 400 |
| City Of The Provider | EAST HARTFORD |
| Zip Code Of The Provider | 061083212 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 182 |
| Number Of Services | 19795 |
| Number Of Medicare Beneficiaries | 3805 |
| Total Submitted Charge Amount | 1395380 |
| Total Medicare Allowed Amount | 318032.57 |
| Total Medicare Payment Amount | 251213.07 |
| Total Medicare Standardized Payment Amount | 239077.66 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 13406 |
| Number Of Medicare Beneficiaries With Drug Services | 163 |
| Total Drug Submitted ChargeAmount | 46754 |
| Total Drug Medicare AllowedAmount | 3709.32 |
| Total Drug Medicare PaymentAmount | 2907.98 |
| Total Drug Medicare Standardized Payment Amount | 2907.98 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 179 |
| Number Of Medical Services | 6389 |
| Number Of Medicare Beneficiaries With Medical Services | 3805 |
| Total Medical Submitted Charge Amount | 1348626 |
| Total Medical Medicare Allowed Amount | 314323.25 |
| Total Medical Medicare Payment Amount | 248305.09 |
| Total Medical Medicare Standardized Payment Amount | 236169.68 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 713 |
| Number Of Beneficiaries Age 65 to 74 | 1262 |
| Number Of Beneficiaries Age 75 to 84 | 1073 |
| Number Of Beneficiaries Age Greater 84 | 757 |
| Number Of Female Beneficiaries | 2446 |
| Number Of Male Beneficiaries | 1359 |
| Number Of Non Hispanic White Beneficiaries | 3087 |
| Number Of Black or African American Beneficiaries | 237 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 385 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 51 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2450 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1355 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.7798 |