| National Provider Identifier [NPI]: | 1255316535 |
| Last Name Of The Provider | LARSON |
| First Name Of The Provider | CRAIG |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3719 DAUPHIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MOBILE |
| Zip Code Of The Provider | 366081753 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 165 |
| Number Of Services | 4950 |
| Number Of Medicare Beneficiaries | 2595 |
| Total Submitted Charge Amount | 520159 |
| Total Medicare Allowed Amount | 136697.98 |
| Total Medicare Payment Amount | 104784.57 |
| Total Medicare Standardized Payment Amount | 112314.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 165 |
| Number Of Medical Services | 4950 |
| Number Of Medicare Beneficiaries With Medical Services | 2595 |
| Total Medical Submitted Charge Amount | 520159 |
| Total Medical Medicare Allowed Amount | 136697.98 |
| Total Medical Medicare Payment Amount | 104784.57 |
| Total Medical Medicare Standardized Payment Amount | 112314.79 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 600 |
| Number Of Beneficiaries Age 65 to 74 | 1009 |
| Number Of Beneficiaries Age 75 to 84 | 640 |
| Number Of Beneficiaries Age Greater 84 | 346 |
| Number Of Female Beneficiaries | 1680 |
| Number Of Male Beneficiaries | 915 |
| Number Of Non Hispanic White Beneficiaries | 1763 |
| Number Of Black or African American Beneficiaries | 781 |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | 11 |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2035 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 560 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.5692 |