| National Provider Identifier [NPI]: | 1083605166 |
| Last Name Of The Provider | MCDONOUGH |
| First Name Of The Provider | MICHELLE |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4500 SAN PABLO RD S |
| Street Address 2 Of The Provider | |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322241865 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 73 |
| Number Of Services | 5175 |
| Number Of Medicare Beneficiaries | 1927 |
| Total Submitted Charge Amount | 431396.84 |
| Total Medicare Allowed Amount | 322681.27 |
| Total Medicare Payment Amount | 260087.4 |
| Total Medicare Standardized Payment Amount | 290761.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 2668 |
| Number Of Medicare Beneficiaries With Drug Services | 52 |
| Total Drug Submitted ChargeAmount | 3281.82 |
| Total Drug Medicare AllowedAmount | 1922.01 |
| Total Drug Medicare PaymentAmount | 1243.34 |
| Total Drug Medicare Standardized Payment Amount | 1243.34 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 67 |
| Number Of Medical Services | 2507 |
| Number Of Medicare Beneficiaries With Medical Services | 1926 |
| Total Medical Submitted Charge Amount | 428115.02 |
| Total Medical Medicare Allowed Amount | 320759.26 |
| Total Medical Medicare Payment Amount | 258844.06 |
| Total Medical Medicare Standardized Payment Amount | 289518.65 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 162 |
| Number Of Beneficiaries Age 65 to 74 | 957 |
| Number Of Beneficiaries Age 75 to 84 | 622 |
| Number Of Beneficiaries Age Greater 84 | 186 |
| Number Of Female Beneficiaries | 1640 |
| Number Of Male Beneficiaries | 287 |
| Number Of Non Hispanic White Beneficiaries | 1711 |
| Number Of Black or African American Beneficiaries | 116 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 41 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 31 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1844 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 83 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2139 |