| National Provider Identifier [NPI]: | 1881674695 |
| Last Name Of The Provider | CAVANAUGH |
| First Name Of The Provider | TERRENCE |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2200 E SHOW LOW LAKE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SHOW LOW |
| Zip Code Of The Provider | 859017881 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 218 |
| Number Of Services | 5748 |
| Number Of Medicare Beneficiaries | 2859 |
| Total Submitted Charge Amount | 850743.79 |
| Total Medicare Allowed Amount | 182400.4 |
| Total Medicare Payment Amount | 136553.66 |
| Total Medicare Standardized Payment Amount | 139067.31 |
| 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 | 218 |
| Number Of Medical Services | 5748 |
| Number Of Medicare Beneficiaries With Medical Services | 2859 |
| Total Medical Submitted Charge Amount | 850743.79 |
| Total Medical Medicare Allowed Amount | 182400.4 |
| Total Medical Medicare Payment Amount | 136553.66 |
| Total Medical Medicare Standardized Payment Amount | 139067.31 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 371 |
| Number Of Beneficiaries Age 65 to 74 | 1380 |
| Number Of Beneficiaries Age 75 to 84 | 833 |
| Number Of Beneficiaries Age Greater 84 | 275 |
| Number Of Female Beneficiaries | 1696 |
| Number Of Male Beneficiaries | 1163 |
| Number Of Non Hispanic White Beneficiaries | 2304 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 137 |
| Number Of American Indian Alaska Native Beneficiaries | 371 |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2346 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 513 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2185 |