| National Provider Identifier [NPI]: | 1053302547 |
| Last Name Of The Provider | BENNETT |
| First Name Of The Provider | LAWRENCE |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3417 ENSIGN RD NE |
| Street Address 2 Of The Provider | |
| City Of The Provider | OLYMPIA |
| Zip Code Of The Provider | 985065075 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 179 |
| Number Of Services | 12170 |
| Number Of Medicare Beneficiaries | 3578 |
| Total Submitted Charge Amount | 1087547.13 |
| Total Medicare Allowed Amount | 390837.39 |
| Total Medicare Payment Amount | 326157.07 |
| Total Medicare Standardized Payment Amount | 336621.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 5686 |
| Number Of Medicare Beneficiaries With Drug Services | 70 |
| Total Drug Submitted ChargeAmount | 4264.91 |
| Total Drug Medicare AllowedAmount | 1550.86 |
| Total Drug Medicare PaymentAmount | 1206.86 |
| Total Drug Medicare Standardized Payment Amount | 1206.86 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 177 |
| Number Of Medical Services | 6484 |
| Number Of Medicare Beneficiaries With Medical Services | 3578 |
| Total Medical Submitted Charge Amount | 1083282.22 |
| Total Medical Medicare Allowed Amount | 389286.53 |
| Total Medical Medicare Payment Amount | 324950.21 |
| Total Medical Medicare Standardized Payment Amount | 335414.76 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 592 |
| Number Of Beneficiaries Age 65 to 74 | 1553 |
| Number Of Beneficiaries Age 75 to 84 | 928 |
| Number Of Beneficiaries Age Greater 84 | 505 |
| Number Of Female Beneficiaries | 2625 |
| Number Of Male Beneficiaries | 953 |
| Number Of Non Hispanic White Beneficiaries | 3250 |
| Number Of Black or African American Beneficiaries | 52 |
| Number Of AsianPacific Islander Beneficiaries | 88 |
| Number Of Hispanic Beneficiaries | 72 |
| Number Of American Indian Alaska Native Beneficiaries | 56 |
| Number Of Beneficiaries With Race Not Else where Classified | 60 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2805 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 773 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 10 |
| 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 | 1.3063 |