| National Provider Identifier [NPI]: | 1609950716 |
| Last Name Of The Provider | MAYO |
| First Name Of The Provider | JACKIEL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3601 TVC |
| Street Address 2 Of The Provider | |
| City Of The Provider | NASHVILLE |
| Zip Code Of The Provider | 372320001 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 118 |
| Number Of Services | 64236 |
| Number Of Medicare Beneficiaries | 1668 |
| Total Submitted Charge Amount | 2132988 |
| Total Medicare Allowed Amount | 458632.93 |
| Total Medicare Payment Amount | 348680.02 |
| Total Medicare Standardized Payment Amount | 390412.13 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 61531 |
| Number Of Medicare Beneficiaries With Drug Services | 702 |
| Total Drug Submitted ChargeAmount | 99278 |
| Total Drug Medicare AllowedAmount | 18173.9 |
| Total Drug Medicare PaymentAmount | 13978.36 |
| Total Drug Medicare Standardized Payment Amount | 13978.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 110 |
| Number Of Medical Services | 2705 |
| Number Of Medicare Beneficiaries With Medical Services | 1667 |
| Total Medical Submitted Charge Amount | 2033710 |
| Total Medical Medicare Allowed Amount | 440459.03 |
| Total Medical Medicare Payment Amount | 334701.66 |
| Total Medical Medicare Standardized Payment Amount | 376433.77 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 374 |
| Number Of Beneficiaries Age 65 to 74 | 760 |
| Number Of Beneficiaries Age 75 to 84 | 427 |
| Number Of Beneficiaries Age Greater 84 | 107 |
| Number Of Female Beneficiaries | 808 |
| Number Of Male Beneficiaries | 860 |
| Number Of Non Hispanic White Beneficiaries | 1506 |
| Number Of Black or African American Beneficiaries | 109 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1446 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 222 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.6803 |