| National Provider Identifier [NPI]: | 1225113301 |
| Last Name Of The Provider | ERICSON |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 14460 NEW FALLS OF NEUSE |
| Street Address 2 Of The Provider | SUITE 149-102 |
| City Of The Provider | RALEIGH |
| Zip Code Of The Provider | 276148227 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 145 |
| Number Of Services | 10761 |
| Number Of Medicare Beneficiaries | 4526 |
| Total Submitted Charge Amount | 922983 |
| Total Medicare Allowed Amount | 279389.3 |
| Total Medicare Payment Amount | 215730.42 |
| Total Medicare Standardized Payment Amount | 224613.83 |
| 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 | 145 |
| Number Of Medical Services | 10761 |
| Number Of Medicare Beneficiaries With Medical Services | 4526 |
| Total Medical Submitted Charge Amount | 922983 |
| Total Medical Medicare Allowed Amount | 279389.3 |
| Total Medical Medicare Payment Amount | 215730.42 |
| Total Medical Medicare Standardized Payment Amount | 224613.83 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 1144 |
| Number Of Beneficiaries Age 65 to 74 | 1733 |
| Number Of Beneficiaries Age 75 to 84 | 1143 |
| Number Of Beneficiaries Age Greater 84 | 506 |
| Number Of Female Beneficiaries | 3189 |
| Number Of Male Beneficiaries | 1337 |
| Number Of Non Hispanic White Beneficiaries | 2164 |
| Number Of Black or African American Beneficiaries | 2245 |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | 44 |
| Number Of Beneficiaries With Race Not Else where Classified | 45 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2627 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1899 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4667 |