| National Provider Identifier [NPI]: | 1912102831 |
| Last Name Of The Provider | BOLAN |
| First Name Of The Provider | CANDICE |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4500 SAN PABLO RD S |
| Street Address 2 Of The Provider | PROVIDER ENROLLMENT |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322241865 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 89 |
| Number Of Services | 37418 |
| Number Of Medicare Beneficiaries | 1147 |
| Total Submitted Charge Amount | 296630.35 |
| Total Medicare Allowed Amount | 199090.18 |
| Total Medicare Payment Amount | 151200.11 |
| Total Medicare Standardized Payment Amount | 171205.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 35856 |
| Number Of Medicare Beneficiaries With Drug Services | 311 |
| Total Drug Submitted ChargeAmount | 34480.72 |
| Total Drug Medicare AllowedAmount | 25652.07 |
| Total Drug Medicare PaymentAmount | 18453.58 |
| Total Drug Medicare Standardized Payment Amount | 18453.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 80 |
| Number Of Medical Services | 1562 |
| Number Of Medicare Beneficiaries With Medical Services | 1088 |
| Total Medical Submitted Charge Amount | 262149.63 |
| Total Medical Medicare Allowed Amount | 173438.11 |
| Total Medical Medicare Payment Amount | 132746.53 |
| Total Medical Medicare Standardized Payment Amount | 152751.54 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 223 |
| Number Of Beneficiaries Age 65 to 74 | 459 |
| Number Of Beneficiaries Age 75 to 84 | 314 |
| Number Of Beneficiaries Age Greater 84 | 151 |
| Number Of Female Beneficiaries | 571 |
| Number Of Male Beneficiaries | 576 |
| Number Of Non Hispanic White Beneficiaries | 982 |
| Number Of Black or African American Beneficiaries | 100 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 44 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 998 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 149 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 2.2406 |