| National Provider Identifier [NPI]: | 1174520134 |
| Last Name Of The Provider | RICHBOURG |
| First Name Of The Provider | SAMUEL |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 601 E ROLLINS ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | ORLANDO |
| Zip Code Of The Provider | 328031248 |
| 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 | 112 |
| Number Of Services | 2601 |
| Number Of Medicare Beneficiaries | 1569 |
| Total Submitted Charge Amount | 177653.48 |
| Total Medicare Allowed Amount | 59143.47 |
| Total Medicare Payment Amount | 45072.97 |
| Total Medicare Standardized Payment Amount | 45575.46 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
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| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 516 |
| Number Of Beneficiaries Age 65 to 74 | 393 |
| Number Of Beneficiaries Age 75 to 84 | 394 |
| Number Of Beneficiaries Age Greater 84 | 266 |
| Number Of Female Beneficiaries | 875 |
| Number Of Male Beneficiaries | 694 |
| Number Of Non Hispanic White Beneficiaries | 1021 |
| Number Of Black or African American Beneficiaries | 261 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 243 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 26 |
| Number Of Beneficiaries With Medicare Only Entitlement | 938 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 631 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 50 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 63 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 23 |
| Average HCC Risk Score Of Beneficiaries | 2.4977 |