| National Provider Identifier [NPI]: | 1477542793 |
| Last Name Of The Provider | HENNING |
| First Name Of The Provider | THEODORE |
| 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 | 500 S UNIVERSITY AVE |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | LITTLE ROCK |
| Zip Code Of The Provider | 722055302 |
| 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 | 193 |
| Number Of Services | 11221 |
| Number Of Medicare Beneficiaries | 5102 |
| Total Submitted Charge Amount | 771722 |
| Total Medicare Allowed Amount | 271187.5 |
| Total Medicare Payment Amount | 206264.26 |
| Total Medicare Standardized Payment Amount | 221476.78 |
| 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 | 193 |
| Number Of Medical Services | 11221 |
| Number Of Medicare Beneficiaries With Medical Services | 5102 |
| Total Medical Submitted Charge Amount | 771722 |
| Total Medical Medicare Allowed Amount | 271187.5 |
| Total Medical Medicare Payment Amount | 206264.26 |
| Total Medical Medicare Standardized Payment Amount | 221476.78 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 1195 |
| Number Of Beneficiaries Age 65 to 74 | 1716 |
| Number Of Beneficiaries Age 75 to 84 | 1470 |
| Number Of Beneficiaries Age Greater 84 | 721 |
| Number Of Female Beneficiaries | 3018 |
| Number Of Male Beneficiaries | 2084 |
| Number Of Non Hispanic White Beneficiaries | 4748 |
| Number Of Black or African American Beneficiaries | 274 |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | 31 |
| Number Of American Indian Alaska Native Beneficiaries | 11 |
| Number Of Beneficiaries With Race Not Else where Classified | 27 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3299 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1803 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.4929 |