| National Provider Identifier [NPI]: | 1992938716 |
| Last Name Of The Provider | OKANOBO |
| First Name Of The Provider | HEITOR |
| 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 | 1575 TREMONT ST APT 408 |
| Street Address 2 Of The Provider | |
| City Of The Provider | BOSTON |
| Zip Code Of The Provider | 02120 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 177 |
| Number Of Services | 6569 |
| Number Of Medicare Beneficiaries | 4420 |
| Total Submitted Charge Amount | 1018420 |
| Total Medicare Allowed Amount | 285881.12 |
| Total Medicare Payment Amount | 221552.67 |
| Total Medicare Standardized Payment Amount | 215424.76 |
| 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 | 177 |
| Number Of Medical Services | 6569 |
| Number Of Medicare Beneficiaries With Medical Services | 4420 |
| Total Medical Submitted Charge Amount | 1018420 |
| Total Medical Medicare Allowed Amount | 285881.12 |
| Total Medical Medicare Payment Amount | 221552.67 |
| Total Medical Medicare Standardized Payment Amount | 215424.76 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 614 |
| Number Of Beneficiaries Age 65 to 74 | 1700 |
| Number Of Beneficiaries Age 75 to 84 | 1339 |
| Number Of Beneficiaries Age Greater 84 | 767 |
| Number Of Female Beneficiaries | 2754 |
| Number Of Male Beneficiaries | 1666 |
| Number Of Non Hispanic White Beneficiaries | 4163 |
| Number Of Black or African American Beneficiaries | 70 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 86 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 83 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3552 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 868 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3113 |