| National Provider Identifier [NPI]: | 1982676664 |
| Last Name Of The Provider | PHILLPOTT |
| First Name Of The Provider | JUSTIN |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2055 NORMANDIE DR |
| Street Address 2 Of The Provider | 108 |
| City Of The Provider | MONTGOMERY |
| Zip Code Of The Provider | 361112732 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 250 |
| Number Of Services | 6990 |
| Number Of Medicare Beneficiaries | 4567 |
| Total Submitted Charge Amount | 747499.27 |
| Total Medicare Allowed Amount | 220003.07 |
| Total Medicare Payment Amount | 159676.43 |
| Total Medicare Standardized Payment Amount | 172306.46 |
| 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 | 6990 |
| Number Of Medicare Beneficiaries With Medical Services | 4567 |
| Total Medical Submitted Charge Amount | 747499.27 |
| Total Medical Medicare Allowed Amount | 220003.07 |
| Total Medical Medicare Payment Amount | 159676.43 |
| Total Medical Medicare Standardized Payment Amount | 172306.46 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 1090 |
| Number Of Beneficiaries Age 65 to 74 | 1643 |
| Number Of Beneficiaries Age 75 to 84 | 1259 |
| Number Of Beneficiaries Age Greater 84 | 575 |
| Number Of Female Beneficiaries | 2729 |
| Number Of Male Beneficiaries | 1838 |
| Number Of Non Hispanic White Beneficiaries | 2952 |
| Number Of Black or African American Beneficiaries | 1540 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 35 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3187 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1380 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.6271 |