| National Provider Identifier [NPI]: | 1053575506 |
| Last Name Of The Provider | ARDOIN |
| First Name Of The Provider | SHANNON |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 44 COLONY RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LITTLE ROCK |
| Zip Code Of The Provider | 722272947 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 142 |
| Number Of Services | 4284 |
| Number Of Medicare Beneficiaries | 2591 |
| Total Submitted Charge Amount | 288629.76 |
| Total Medicare Allowed Amount | 95251.46 |
| Total Medicare Payment Amount | 69251.29 |
| Total Medicare Standardized Payment Amount | 72353.18 |
| 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 | 142 |
| Number Of Medical Services | 4284 |
| Number Of Medicare Beneficiaries With Medical Services | 2591 |
| Total Medical Submitted Charge Amount | 288629.76 |
| Total Medical Medicare Allowed Amount | 95251.46 |
| Total Medical Medicare Payment Amount | 69251.29 |
| Total Medical Medicare Standardized Payment Amount | 72353.18 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 559 |
| Number Of Beneficiaries Age 65 to 74 | 819 |
| Number Of Beneficiaries Age 75 to 84 | 776 |
| Number Of Beneficiaries Age Greater 84 | 437 |
| Number Of Female Beneficiaries | 1546 |
| Number Of Male Beneficiaries | 1045 |
| Number Of Non Hispanic White Beneficiaries | 1661 |
| Number Of Black or African American Beneficiaries | 902 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1193 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1398 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 59 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.5097 |