| National Provider Identifier [NPI]: | 1578541439 |
| Last Name Of The Provider | SHACKELFORD |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 300 SINGLETON RIDGE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | CONWAY |
| Zip Code Of The Provider | 295269142 |
| State Code Of The Provider | SC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 196 |
| Number Of Services | 8248 |
| Number Of Medicare Beneficiaries | 3970 |
| Total Submitted Charge Amount | 953843.98 |
| Total Medicare Allowed Amount | 213773.27 |
| Total Medicare Payment Amount | 157851.56 |
| Total Medicare Standardized Payment Amount | 171192.49 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1956 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 3916.5 |
| Total Drug Medicare AllowedAmount | 572.72 |
| Total Drug Medicare PaymentAmount | 439.11 |
| Total Drug Medicare Standardized Payment Amount | 439.11 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 194 |
| Number Of Medical Services | 6292 |
| Number Of Medicare Beneficiaries With Medical Services | 3970 |
| Total Medical Submitted Charge Amount | 949927.48 |
| Total Medical Medicare Allowed Amount | 213200.55 |
| Total Medical Medicare Payment Amount | 157412.45 |
| Total Medical Medicare Standardized Payment Amount | 170753.38 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 839 |
| Number Of Beneficiaries Age 65 to 74 | 1494 |
| Number Of Beneficiaries Age 75 to 84 | 1086 |
| Number Of Beneficiaries Age Greater 84 | 551 |
| Number Of Female Beneficiaries | 2389 |
| Number Of Male Beneficiaries | 1581 |
| Number Of Non Hispanic White Beneficiaries | 3674 |
| Number Of Black or African American Beneficiaries | 238 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 35 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2794 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1176 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5555 |