| National Provider Identifier [NPI]: | 1871558502 |
| Last Name Of The Provider | LIVELY |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2500 E MAIN |
| Street Address 2 Of The Provider | |
| City Of The Provider | ALICE |
| Zip Code Of The Provider | 78332 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 84 |
| Number Of Services | 863 |
| Number Of Medicare Beneficiaries | 517 |
| Total Submitted Charge Amount | 74948 |
| Total Medicare Allowed Amount | 18448.15 |
| Total Medicare Payment Amount | 13801.83 |
| Total Medicare Standardized Payment Amount | 14357.54 |
| 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 | 84 |
| Number Of Medical Services | 863 |
| Number Of Medicare Beneficiaries With Medical Services | 517 |
| Total Medical Submitted Charge Amount | 74948 |
| Total Medical Medicare Allowed Amount | 18448.15 |
| Total Medical Medicare Payment Amount | 13801.83 |
| Total Medical Medicare Standardized Payment Amount | 14357.54 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 107 |
| Number Of Beneficiaries Age 65 to 74 | 136 |
| Number Of Beneficiaries Age 75 to 84 | 154 |
| Number Of Beneficiaries Age Greater 84 | 120 |
| Number Of Female Beneficiaries | 289 |
| Number Of Male Beneficiaries | 228 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 489 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 142 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 375 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 38 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 55 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 38 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 74 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 70 |
| Percent Of With Osteoporosis | 20 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 61 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.8581 |