| National Provider Identifier [NPI]: | 1477539484 |
| Last Name Of The Provider | MONTGOMERY |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 85 SEYMOUR ST |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | HARTFORD |
| Zip Code Of The Provider | 061065501 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 147 |
| Number Of Services | 6323 |
| Number Of Medicare Beneficiaries | 2248 |
| Total Submitted Charge Amount | 964207 |
| Total Medicare Allowed Amount | 199691.97 |
| Total Medicare Payment Amount | 149888.11 |
| Total Medicare Standardized Payment Amount | 139050.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 3003 |
| Number Of Medicare Beneficiaries With Drug Services | 117 |
| Total Drug Submitted ChargeAmount | 12119 |
| Total Drug Medicare AllowedAmount | 1643.78 |
| Total Drug Medicare PaymentAmount | 1246.53 |
| Total Drug Medicare Standardized Payment Amount | 1246.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 140 |
| Number Of Medical Services | 3320 |
| Number Of Medicare Beneficiaries With Medical Services | 2245 |
| Total Medical Submitted Charge Amount | 952088 |
| Total Medical Medicare Allowed Amount | 198048.19 |
| Total Medical Medicare Payment Amount | 148641.58 |
| Total Medical Medicare Standardized Payment Amount | 137803.75 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 420 |
| Number Of Beneficiaries Age 65 to 74 | 755 |
| Number Of Beneficiaries Age 75 to 84 | 602 |
| Number Of Beneficiaries Age Greater 84 | 471 |
| Number Of Female Beneficiaries | 1393 |
| Number Of Male Beneficiaries | 855 |
| Number Of Non Hispanic White Beneficiaries | 1882 |
| Number Of Black or African American Beneficiaries | 109 |
| Number Of AsianPacific Islander Beneficiaries | 27 |
| Number Of Hispanic Beneficiaries | 192 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 38 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1459 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 789 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.5446 |