| National Provider Identifier [NPI]: | 1629160197 |
| Last Name Of The Provider | LAFERRIERE |
| First Name Of The Provider | SHAWN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7950 MARTIN LOOP |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT BENNING |
| Zip Code Of The Provider | 319055647 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 145 |
| Number Of Services | 5208 |
| Number Of Medicare Beneficiaries | 2163 |
| Total Submitted Charge Amount | 452715 |
| Total Medicare Allowed Amount | 147342.78 |
| Total Medicare Payment Amount | 108795.19 |
| Total Medicare Standardized Payment Amount | 114600.31 |
| 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 | 145 |
| Number Of Medical Services | 5208 |
| Number Of Medicare Beneficiaries With Medical Services | 2163 |
| Total Medical Submitted Charge Amount | 452715 |
| Total Medical Medicare Allowed Amount | 147342.78 |
| Total Medical Medicare Payment Amount | 108795.19 |
| Total Medical Medicare Standardized Payment Amount | 114600.31 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 503 |
| Number Of Beneficiaries Age 65 to 74 | 766 |
| Number Of Beneficiaries Age 75 to 84 | 596 |
| Number Of Beneficiaries Age Greater 84 | 298 |
| Number Of Female Beneficiaries | 1358 |
| Number Of Male Beneficiaries | 805 |
| Number Of Non Hispanic White Beneficiaries | 2107 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 22 |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 851 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1312 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.3024 |