| National Provider Identifier [NPI]: | 1790939502 |
| Last Name Of The Provider | MAXWELL |
| First Name Of The Provider | JEFFRY |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6424 E BROADWAY RD |
| Street Address 2 Of The Provider | STE 101 |
| City Of The Provider | MESA |
| Zip Code Of The Provider | 852061750 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 192 |
| Number Of Services | 13624 |
| Number Of Medicare Beneficiaries | 2424 |
| Total Submitted Charge Amount | 934694.1 |
| Total Medicare Allowed Amount | 219309.98 |
| Total Medicare Payment Amount | 170731.19 |
| Total Medicare Standardized Payment Amount | 175727.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 10343 |
| Number Of Medicare Beneficiaries With Drug Services | 112 |
| Total Drug Submitted ChargeAmount | 20546.1 |
| Total Drug Medicare AllowedAmount | 2786.65 |
| Total Drug Medicare PaymentAmount | 2181.48 |
| Total Drug Medicare Standardized Payment Amount | 2181.48 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 188 |
| Number Of Medical Services | 3281 |
| Number Of Medicare Beneficiaries With Medical Services | 2424 |
| Total Medical Submitted Charge Amount | 914148 |
| Total Medical Medicare Allowed Amount | 216523.33 |
| Total Medical Medicare Payment Amount | 168549.71 |
| Total Medical Medicare Standardized Payment Amount | 173545.6 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 286 |
| Number Of Beneficiaries Age 65 to 74 | 1048 |
| Number Of Beneficiaries Age 75 to 84 | 756 |
| Number Of Beneficiaries Age Greater 84 | 334 |
| Number Of Female Beneficiaries | 1326 |
| Number Of Male Beneficiaries | 1098 |
| Number Of Non Hispanic White Beneficiaries | 2069 |
| Number Of Black or African American Beneficiaries | 151 |
| Number Of AsianPacific Islander Beneficiaries | 29 |
| Number Of Hispanic Beneficiaries | 108 |
| Number Of American Indian Alaska Native Beneficiaries | 38 |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2119 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 305 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.8132 |