| National Provider Identifier [NPI]: | 1841281417 |
| Last Name Of The Provider | LEVINE |
| First Name Of The Provider | SCOTT |
| 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 | 20 CATAMORE BLVD |
| Street Address 2 Of The Provider | RHODE ISLAND MEDICAL IMAGING |
| City Of The Provider | EAST PROVIDENCE |
| Zip Code Of The Provider | 029141204 |
| State Code Of The Provider | RI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 137 |
| Number Of Services | 14594 |
| Number Of Medicare Beneficiaries | 2686 |
| Total Submitted Charge Amount | 1083788.5 |
| Total Medicare Allowed Amount | 266303.74 |
| Total Medicare Payment Amount | 197417.48 |
| Total Medicare Standardized Payment Amount | 192402.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 10430 |
| Number Of Medicare Beneficiaries With Drug Services | 107 |
| Total Drug Submitted ChargeAmount | 11248.5 |
| Total Drug Medicare AllowedAmount | 4311.85 |
| Total Drug Medicare PaymentAmount | 3366.76 |
| Total Drug Medicare Standardized Payment Amount | 3366.76 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 133 |
| Number Of Medical Services | 4164 |
| Number Of Medicare Beneficiaries With Medical Services | 2686 |
| Total Medical Submitted Charge Amount | 1072540 |
| Total Medical Medicare Allowed Amount | 261991.89 |
| Total Medical Medicare Payment Amount | 194050.72 |
| Total Medical Medicare Standardized Payment Amount | 189035.75 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 693 |
| Number Of Beneficiaries Age 65 to 74 | 1022 |
| Number Of Beneficiaries Age 75 to 84 | 624 |
| Number Of Beneficiaries Age Greater 84 | 347 |
| Number Of Female Beneficiaries | 1680 |
| Number Of Male Beneficiaries | 1006 |
| Number Of Non Hispanic White Beneficiaries | 2137 |
| Number Of Black or African American Beneficiaries | 138 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 314 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 72 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1737 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 949 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4183 |