| National Provider Identifier [NPI]: | 1366555328 |
| Last Name Of The Provider | PHILLIPS |
| First Name Of The Provider | EDWARD |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1405 N STATE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | JACKSON |
| Zip Code Of The Provider | 392021642 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 253 |
| Number Of Services | 4987 |
| Number Of Medicare Beneficiaries | 3288 |
| Total Submitted Charge Amount | 1752060.5 |
| Total Medicare Allowed Amount | 205951.93 |
| Total Medicare Payment Amount | 158655.55 |
| Total Medicare Standardized Payment Amount | 169216.46 |
| 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 | 253 |
| Number Of Medical Services | 4987 |
| Number Of Medicare Beneficiaries With Medical Services | 3288 |
| Total Medical Submitted Charge Amount | 1752060.5 |
| Total Medical Medicare Allowed Amount | 205951.93 |
| Total Medical Medicare Payment Amount | 158655.55 |
| Total Medical Medicare Standardized Payment Amount | 169216.46 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 541 |
| Number Of Beneficiaries Age 65 to 74 | 1149 |
| Number Of Beneficiaries Age 75 to 84 | 1081 |
| Number Of Beneficiaries Age Greater 84 | 517 |
| Number Of Female Beneficiaries | 2072 |
| Number Of Male Beneficiaries | 1216 |
| Number Of Non Hispanic White Beneficiaries | 2316 |
| Number Of Black or African American Beneficiaries | 938 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2282 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1006 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.8427 |