| National Provider Identifier [NPI]: | 1265480321 |
| Last Name Of The Provider | NIES |
| First Name Of The Provider | DONALD |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1800 BARRS ST |
| Street Address 2 Of The Provider | DEPARTMENT OF RADIOLOGY |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322044704 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 164 |
| Number Of Services | 18555 |
| Number Of Medicare Beneficiaries | 7629 |
| Total Submitted Charge Amount | 1041752.06 |
| Total Medicare Allowed Amount | 344465.91 |
| Total Medicare Payment Amount | 261085.05 |
| Total Medicare Standardized Payment Amount | 264277.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 7728 |
| Number Of Medicare Beneficiaries With Drug Services | 59 |
| Total Drug Submitted ChargeAmount | 3419.83 |
| Total Drug Medicare AllowedAmount | 1442.84 |
| Total Drug Medicare PaymentAmount | 1122.7 |
| Total Drug Medicare Standardized Payment Amount | 1122.7 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 163 |
| Number Of Medical Services | 10827 |
| Number Of Medicare Beneficiaries With Medical Services | 7627 |
| Total Medical Submitted Charge Amount | 1038332.23 |
| Total Medical Medicare Allowed Amount | 343023.07 |
| Total Medical Medicare Payment Amount | 259962.35 |
| Total Medical Medicare Standardized Payment Amount | 263155.13 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 1546 |
| Number Of Beneficiaries Age 65 to 74 | 2296 |
| Number Of Beneficiaries Age 75 to 84 | 2197 |
| Number Of Beneficiaries Age Greater 84 | 1590 |
| Number Of Female Beneficiaries | 4508 |
| Number Of Male Beneficiaries | 3121 |
| Number Of Non Hispanic White Beneficiaries | 5386 |
| Number Of Black or African American Beneficiaries | 923 |
| Number Of AsianPacific Islander Beneficiaries | 105 |
| Number Of Hispanic Beneficiaries | 1116 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 5322 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 2307 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 49 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 62 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.2902 |