| National Provider Identifier [NPI]: | 1447233713 |
| Last Name Of The Provider | BATHALA |
| First Name Of The Provider | ELIZABETH |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4201 BELFORT RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322161431 |
| 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 | 193 |
| Number Of Services | 8141 |
| Number Of Medicare Beneficiaries | 4574 |
| Total Submitted Charge Amount | 1243282.63 |
| Total Medicare Allowed Amount | 229729.78 |
| Total Medicare Payment Amount | 174547.08 |
| Total Medicare Standardized Payment Amount | 175378.08 |
| 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 | 193 |
| Number Of Medical Services | 8141 |
| Number Of Medicare Beneficiaries With Medical Services | 4574 |
| Total Medical Submitted Charge Amount | 1243282.63 |
| Total Medical Medicare Allowed Amount | 229729.78 |
| Total Medical Medicare Payment Amount | 174547.08 |
| Total Medical Medicare Standardized Payment Amount | 175378.08 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 782 |
| Number Of Beneficiaries Age 65 to 74 | 1750 |
| Number Of Beneficiaries Age 75 to 84 | 1298 |
| Number Of Beneficiaries Age Greater 84 | 744 |
| Number Of Female Beneficiaries | 2870 |
| Number Of Male Beneficiaries | 1704 |
| Number Of Non Hispanic White Beneficiaries | 3574 |
| Number Of Black or African American Beneficiaries | 764 |
| Number Of AsianPacific Islander Beneficiaries | 52 |
| Number Of Hispanic Beneficiaries | 130 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 3560 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1014 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 59 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.7998 |