| National Provider Identifier [NPI]: | 1134139983 |
| Last Name Of The Provider | CROCKETT |
| First Name Of The Provider | MICHELE |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5002 COWHORN CREEK RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | TEXARKANA |
| Zip Code Of The Provider | 755039766 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 132 |
| Number Of Services | 42436 |
| Number Of Medicare Beneficiaries | 3043 |
| Total Submitted Charge Amount | 1918816.2 |
| Total Medicare Allowed Amount | 484770.35 |
| Total Medicare Payment Amount | 373034.68 |
| Total Medicare Standardized Payment Amount | 409407.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 37721 |
| Number Of Medicare Beneficiaries With Drug Services | 524 |
| Total Drug Submitted ChargeAmount | 88912.5 |
| Total Drug Medicare AllowedAmount | 15379.06 |
| Total Drug Medicare PaymentAmount | 11766.65 |
| Total Drug Medicare Standardized Payment Amount | 11766.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 125 |
| Number Of Medical Services | 4715 |
| Number Of Medicare Beneficiaries With Medical Services | 3043 |
| Total Medical Submitted Charge Amount | 1829903.7 |
| Total Medical Medicare Allowed Amount | 469391.29 |
| Total Medical Medicare Payment Amount | 361268.03 |
| Total Medical Medicare Standardized Payment Amount | 397640.75 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 379 |
| Number Of Beneficiaries Age 65 to 74 | 1397 |
| Number Of Beneficiaries Age 75 to 84 | 962 |
| Number Of Beneficiaries Age Greater 84 | 305 |
| Number Of Female Beneficiaries | 2030 |
| Number Of Male Beneficiaries | 1013 |
| Number Of Non Hispanic White Beneficiaries | 2596 |
| Number Of Black or African American Beneficiaries | 397 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2663 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 380 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1368 |