| National Provider Identifier [NPI]: | 1578518171 |
| Last Name Of The Provider | MONTANEZ |
| First Name Of The Provider | JOSUE |
| 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 | 1 MEDICAL CENTER BOULEVARD |
| Street Address 2 Of The Provider | DEPARTMENT OF RADIOLOGY |
| City Of The Provider | COOKEVILLE |
| Zip Code Of The Provider | 38501 |
| 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 | 250 |
| Number Of Services | 11882 |
| Number Of Medicare Beneficiaries | 5616 |
| Total Submitted Charge Amount | 1099867 |
| Total Medicare Allowed Amount | 350683.85 |
| Total Medicare Payment Amount | 268106.57 |
| Total Medicare Standardized Payment Amount | 285575.02 |
| 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 | 250 |
| Number Of Medical Services | 11882 |
| Number Of Medicare Beneficiaries With Medical Services | 5616 |
| Total Medical Submitted Charge Amount | 1099867 |
| Total Medical Medicare Allowed Amount | 350683.85 |
| Total Medical Medicare Payment Amount | 268106.57 |
| Total Medical Medicare Standardized Payment Amount | 285575.02 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 1101 |
| Number Of Beneficiaries Age 65 to 74 | 2303 |
| Number Of Beneficiaries Age 75 to 84 | 1569 |
| Number Of Beneficiaries Age Greater 84 | 643 |
| Number Of Female Beneficiaries | 3274 |
| Number Of Male Beneficiaries | 2342 |
| Number Of Non Hispanic White Beneficiaries | 5462 |
| Number Of Black or African American Beneficiaries | 53 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 45 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 39 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3928 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1688 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.5876 |