| National Provider Identifier [NPI]: | 1669428603 |
| Last Name Of The Provider | BOUGHNER |
| First Name Of The Provider | BRICE |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1224 TROTWOOD AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | COLUMBIA |
| Zip Code Of The Provider | 384014802 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 197 |
| Number Of Services | 8073 |
| Number Of Medicare Beneficiaries | 4125 |
| Total Submitted Charge Amount | 1026694.56 |
| Total Medicare Allowed Amount | 227097.93 |
| Total Medicare Payment Amount | 168913.83 |
| Total Medicare Standardized Payment Amount | 182346.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1576 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 3834 |
| Total Drug Medicare AllowedAmount | 639.77 |
| Total Drug Medicare PaymentAmount | 487.98 |
| Total Drug Medicare Standardized Payment Amount | 487.98 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 195 |
| Number Of Medical Services | 6497 |
| Number Of Medicare Beneficiaries With Medical Services | 4124 |
| Total Medical Submitted Charge Amount | 1022860.56 |
| Total Medical Medicare Allowed Amount | 226458.16 |
| Total Medical Medicare Payment Amount | 168425.85 |
| Total Medical Medicare Standardized Payment Amount | 181858.95 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 874 |
| Number Of Beneficiaries Age 65 to 74 | 1436 |
| Number Of Beneficiaries Age 75 to 84 | 1214 |
| Number Of Beneficiaries Age Greater 84 | 601 |
| Number Of Female Beneficiaries | 2462 |
| Number Of Male Beneficiaries | 1663 |
| Number Of Non Hispanic White Beneficiaries | 3831 |
| Number Of Black or African American Beneficiaries | 235 |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | 29 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2837 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1288 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5841 |