| National Provider Identifier [NPI]: | 1164606042 |
| Last Name Of The Provider | WATSON |
| First Name Of The Provider | JUSTIN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 55 WHITCHER STREET 250 |
| Street Address 2 Of The Provider | |
| City Of The Provider | MARIETTA |
| Zip Code Of The Provider | 30060 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 106 |
| Number Of Services | 2441 |
| Number Of Medicare Beneficiaries | 547 |
| Total Submitted Charge Amount | 520544.5 |
| Total Medicare Allowed Amount | 192707.72 |
| Total Medicare Payment Amount | 147723.24 |
| Total Medicare Standardized Payment Amount | 147561.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 559 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 71242 |
| Total Drug Medicare AllowedAmount | 17734.7 |
| Total Drug Medicare PaymentAmount | 13903.45 |
| Total Drug Medicare Standardized Payment Amount | 13903.45 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 100 |
| Number Of Medical Services | 1882 |
| Number Of Medicare Beneficiaries With Medical Services | 547 |
| Total Medical Submitted Charge Amount | 449302.5 |
| Total Medical Medicare Allowed Amount | 174973.02 |
| Total Medical Medicare Payment Amount | 133819.79 |
| Total Medical Medicare Standardized Payment Amount | 133658.48 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 63 |
| Number Of Beneficiaries Age 65 to 74 | 230 |
| Number Of Beneficiaries Age 75 to 84 | 176 |
| Number Of Beneficiaries Age Greater 84 | 78 |
| Number Of Female Beneficiaries | 176 |
| Number Of Male Beneficiaries | 371 |
| Number Of Non Hispanic White Beneficiaries | 480 |
| Number Of Black or African American Beneficiaries | 40 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 486 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 61 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4128 |