| National Provider Identifier [NPI]: | 1104848902 |
| Last Name Of The Provider | HENRY |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 687 TILMAN RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHARLOTTESVILLE |
| Zip Code Of The Provider | 229037060 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 142 |
| Number Of Services | 13665 |
| Number Of Medicare Beneficiaries | 1974 |
| Total Submitted Charge Amount | 4410509.04 |
| Total Medicare Allowed Amount | 283798.14 |
| Total Medicare Payment Amount | 213679.08 |
| Total Medicare Standardized Payment Amount | 224483.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 11063 |
| Number Of Medicare Beneficiaries With Drug Services | 440 |
| Total Drug Submitted ChargeAmount | 59298.04 |
| Total Drug Medicare AllowedAmount | 7570.32 |
| Total Drug Medicare PaymentAmount | 5874.66 |
| Total Drug Medicare Standardized Payment Amount | 5874.66 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 136 |
| Number Of Medical Services | 2602 |
| Number Of Medicare Beneficiaries With Medical Services | 1974 |
| Total Medical Submitted Charge Amount | 4351211 |
| Total Medical Medicare Allowed Amount | 276227.82 |
| Total Medical Medicare Payment Amount | 207804.42 |
| Total Medical Medicare Standardized Payment Amount | 218608.87 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 444 |
| Number Of Beneficiaries Age 65 to 74 | 883 |
| Number Of Beneficiaries Age 75 to 84 | 517 |
| Number Of Beneficiaries Age Greater 84 | 130 |
| Number Of Female Beneficiaries | 1125 |
| Number Of Male Beneficiaries | 849 |
| Number Of Non Hispanic White Beneficiaries | 1672 |
| Number Of Black or African American Beneficiaries | 217 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 45 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1518 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 456 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4821 |