| National Provider Identifier [NPI]: | 1902826233 |
| Last Name Of The Provider | AULTMAN |
| First Name Of The Provider | CHAD |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5422 DIJON DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | BATON ROUGE |
| Zip Code Of The Provider | 708084315 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 199 |
| Number Of Services | 7472 |
| Number Of Medicare Beneficiaries | 3915 |
| Total Submitted Charge Amount | 577680 |
| Total Medicare Allowed Amount | 151179.48 |
| Total Medicare Payment Amount | 115877.76 |
| Total Medicare Standardized Payment Amount | 128146.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1253 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 2628 |
| Total Drug Medicare AllowedAmount | 520.63 |
| Total Drug Medicare PaymentAmount | 408.12 |
| Total Drug Medicare Standardized Payment Amount | 408.12 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 197 |
| Number Of Medical Services | 6219 |
| Number Of Medicare Beneficiaries With Medical Services | 3915 |
| Total Medical Submitted Charge Amount | 575052 |
| Total Medical Medicare Allowed Amount | 150658.85 |
| Total Medical Medicare Payment Amount | 115469.64 |
| Total Medical Medicare Standardized Payment Amount | 127738.72 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 1098 |
| Number Of Beneficiaries Age 65 to 74 | 1295 |
| Number Of Beneficiaries Age 75 to 84 | 950 |
| Number Of Beneficiaries Age Greater 84 | 572 |
| Number Of Female Beneficiaries | 2314 |
| Number Of Male Beneficiaries | 1601 |
| Number Of Non Hispanic White Beneficiaries | 2090 |
| Number Of Black or African American Beneficiaries | 1732 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 49 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2168 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1747 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.1017 |