| National Provider Identifier [NPI]: | 1457396020 |
| Last Name Of The Provider | DOUGHERTY |
| First Name Of The Provider | SARSFIELD |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3205 S RUSSELL ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MISSOULA |
| Zip Code Of The Provider | 598018536 |
| State Code Of The Provider | MT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 211 |
| Number Of Services | 3722 |
| Number Of Medicare Beneficiaries | 2460 |
| Total Submitted Charge Amount | 471044 |
| Total Medicare Allowed Amount | 157513.57 |
| Total Medicare Payment Amount | 117720.36 |
| Total Medicare Standardized Payment Amount | 117739.57 |
| 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 | 211 |
| Number Of Medical Services | 3722 |
| Number Of Medicare Beneficiaries With Medical Services | 2460 |
| Total Medical Submitted Charge Amount | 471044 |
| Total Medical Medicare Allowed Amount | 157513.57 |
| Total Medical Medicare Payment Amount | 117720.36 |
| Total Medical Medicare Standardized Payment Amount | 117739.57 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 372 |
| Number Of Beneficiaries Age 65 to 74 | 975 |
| Number Of Beneficiaries Age 75 to 84 | 740 |
| Number Of Beneficiaries Age Greater 84 | 373 |
| Number Of Female Beneficiaries | 1270 |
| Number Of Male Beneficiaries | 1190 |
| Number Of Non Hispanic White Beneficiaries | 2297 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 105 |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1953 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 507 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3969 |