| National Provider Identifier [NPI]: | 1992761746 |
| Last Name Of The Provider | LEB |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1680 DUNLAWTON AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORT ORANGE |
| Zip Code Of The Provider | 321274754 |
| 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 | 131 |
| Number Of Services | 4515 |
| Number Of Medicare Beneficiaries | 3272 |
| Total Submitted Charge Amount | 545029 |
| Total Medicare Allowed Amount | 147808.69 |
| Total Medicare Payment Amount | 113272.94 |
| Total Medicare Standardized Payment Amount | 113555.67 |
| 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 | 131 |
| Number Of Medical Services | 4515 |
| Number Of Medicare Beneficiaries With Medical Services | 3272 |
| Total Medical Submitted Charge Amount | 545029 |
| Total Medical Medicare Allowed Amount | 147808.69 |
| Total Medical Medicare Payment Amount | 113272.94 |
| Total Medical Medicare Standardized Payment Amount | 113555.67 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 466 |
| Number Of Beneficiaries Age 65 to 74 | 1057 |
| Number Of Beneficiaries Age 75 to 84 | 1099 |
| Number Of Beneficiaries Age Greater 84 | 650 |
| Number Of Female Beneficiaries | 1849 |
| Number Of Male Beneficiaries | 1423 |
| Number Of Non Hispanic White Beneficiaries | 2840 |
| Number Of Black or African American Beneficiaries | 166 |
| Number Of AsianPacific Islander Beneficiaries | 29 |
| Number Of Hispanic Beneficiaries | 209 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2455 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 817 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 40 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 63 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.8265 |