| National Provider Identifier [NPI]: | 1629075072 |
| Last Name Of The Provider | MAYNARD |
| First Name Of The Provider | SAMUEL |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1112 E WEISGARBER RD |
| Street Address 2 Of The Provider | STE 201 |
| City Of The Provider | KNOXVILLE |
| Zip Code Of The Provider | 379092647 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 218 |
| Number Of Services | 4910 |
| Number Of Medicare Beneficiaries | 2377 |
| Total Submitted Charge Amount | 538376.28 |
| Total Medicare Allowed Amount | 158484.47 |
| Total Medicare Payment Amount | 125706.65 |
| Total Medicare Standardized Payment Amount | 135474.25 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 1172 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 1885.15 |
| Total Drug Medicare AllowedAmount | 556.24 |
| Total Drug Medicare PaymentAmount | 436.1 |
| Total Drug Medicare Standardized Payment Amount | 436.1 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 214 |
| Number Of Medical Services | 3738 |
| Number Of Medicare Beneficiaries With Medical Services | 2377 |
| Total Medical Submitted Charge Amount | 536491.13 |
| Total Medical Medicare Allowed Amount | 157928.23 |
| Total Medical Medicare Payment Amount | 125270.55 |
| Total Medical Medicare Standardized Payment Amount | 135038.15 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 520 |
| Number Of Beneficiaries Age 65 to 74 | 901 |
| Number Of Beneficiaries Age 75 to 84 | 645 |
| Number Of Beneficiaries Age Greater 84 | 311 |
| Number Of Female Beneficiaries | 1587 |
| Number Of Male Beneficiaries | 790 |
| Number Of Non Hispanic White Beneficiaries | 2259 |
| Number Of Black or African American Beneficiaries | 88 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1670 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 707 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.451 |