| National Provider Identifier [NPI]: | 1194701649 |
| Last Name Of The Provider | CHURCH |
| First Name Of The Provider | JOHN |
| 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 | 1502 N THORNTON AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | DALTON |
| Zip Code Of The Provider | 307203064 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 155 |
| Number Of Services | 7452 |
| Number Of Medicare Beneficiaries | 1344 |
| Total Submitted Charge Amount | 1434829.67 |
| Total Medicare Allowed Amount | 331252.7 |
| Total Medicare Payment Amount | 266610.86 |
| Total Medicare Standardized Payment Amount | 299454.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 4502 |
| Number Of Medicare Beneficiaries With Drug Services | 116 |
| Total Drug Submitted ChargeAmount | 7267.23 |
| Total Drug Medicare AllowedAmount | 2699.24 |
| Total Drug Medicare PaymentAmount | 2099.83 |
| Total Drug Medicare Standardized Payment Amount | 2099.83 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 151 |
| Number Of Medical Services | 2950 |
| Number Of Medicare Beneficiaries With Medical Services | 1344 |
| Total Medical Submitted Charge Amount | 1427562.44 |
| Total Medical Medicare Allowed Amount | 328553.46 |
| Total Medical Medicare Payment Amount | 264511.03 |
| Total Medical Medicare Standardized Payment Amount | 297354.7 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 374 |
| Number Of Beneficiaries Age 65 to 74 | 638 |
| Number Of Beneficiaries Age 75 to 84 | 282 |
| Number Of Beneficiaries Age Greater 84 | 50 |
| Number Of Female Beneficiaries | 1080 |
| Number Of Male Beneficiaries | 264 |
| Number Of Non Hispanic White Beneficiaries | 1257 |
| Number Of Black or African American Beneficiaries | 27 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 47 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1010 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 334 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 12 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.993 |