| National Provider Identifier [NPI]: | 1356317689 |
| Last Name Of The Provider | NELSON |
| First Name Of The Provider | RICHARD |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2322 S 57TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT SMITH |
| Zip Code Of The Provider | 729033813 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 263 |
| Number Of Services | 9039 |
| Number Of Medicare Beneficiaries | 4781 |
| Total Submitted Charge Amount | 918038.5 |
| Total Medicare Allowed Amount | 238738.45 |
| Total Medicare Payment Amount | 185864.59 |
| Total Medicare Standardized Payment Amount | 202395.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 635 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 1017.5 |
| Total Drug Medicare AllowedAmount | 147.76 |
| Total Drug Medicare PaymentAmount | 113.84 |
| Total Drug Medicare Standardized Payment Amount | 113.84 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 261 |
| Number Of Medical Services | 8404 |
| Number Of Medicare Beneficiaries With Medical Services | 4781 |
| Total Medical Submitted Charge Amount | 917021 |
| Total Medical Medicare Allowed Amount | 238590.69 |
| Total Medical Medicare Payment Amount | 185750.75 |
| Total Medical Medicare Standardized Payment Amount | 202281.64 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 1014 |
| Number Of Beneficiaries Age 65 to 74 | 1780 |
| Number Of Beneficiaries Age 75 to 84 | 1359 |
| Number Of Beneficiaries Age Greater 84 | 628 |
| Number Of Female Beneficiaries | 3026 |
| Number Of Male Beneficiaries | 1755 |
| Number Of Non Hispanic White Beneficiaries | 4409 |
| Number Of Black or African American Beneficiaries | 102 |
| Number Of AsianPacific Islander Beneficiaries | 34 |
| Number Of Hispanic Beneficiaries | 55 |
| Number Of American Indian Alaska Native Beneficiaries | 153 |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3451 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1330 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.436 |