| National Provider Identifier [NPI]: | 1992745715 |
| Last Name Of The Provider | ANDELMAN |
| First Name Of The Provider | SAMUEL |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 106 BLANCA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | ALAMOSA |
| Zip Code Of The Provider | 811012340 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 124 |
| Number Of Services | 11884 |
| Number Of Medicare Beneficiaries | 2248 |
| Total Submitted Charge Amount | 976866.5 |
| Total Medicare Allowed Amount | 280667.1 |
| Total Medicare Payment Amount | 221538.61 |
| Total Medicare Standardized Payment Amount | 208819.31 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 8390 |
| Number Of Medicare Beneficiaries With Drug Services | 83 |
| Total Drug Submitted ChargeAmount | 10487.5 |
| Total Drug Medicare AllowedAmount | 1523.55 |
| Total Drug Medicare PaymentAmount | 1067.68 |
| Total Drug Medicare Standardized Payment Amount | 1067.68 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 123 |
| Number Of Medical Services | 3494 |
| Number Of Medicare Beneficiaries With Medical Services | 2248 |
| Total Medical Submitted Charge Amount | 966379 |
| Total Medical Medicare Allowed Amount | 279143.55 |
| Total Medical Medicare Payment Amount | 220470.93 |
| Total Medical Medicare Standardized Payment Amount | 207751.63 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 349 |
| Number Of Beneficiaries Age 65 to 74 | 1060 |
| Number Of Beneficiaries Age 75 to 84 | 609 |
| Number Of Beneficiaries Age Greater 84 | 230 |
| Number Of Female Beneficiaries | 1629 |
| Number Of Male Beneficiaries | 619 |
| Number Of Non Hispanic White Beneficiaries | 1492 |
| Number Of Black or African American Beneficiaries | 567 |
| Number Of AsianPacific Islander Beneficiaries | 100 |
| Number Of Hispanic Beneficiaries | 45 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1784 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 464 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.2558 |