| National Provider Identifier [NPI]: | 1184879710 |
| Last Name Of The Provider | KEANE |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2602 PRENDERGAST PL |
| Street Address 2 Of The Provider | |
| City Of The Provider | REYNOLDSBURG |
| Zip Code Of The Provider | 430685207 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 281 |
| Number Of Services | 3878 |
| Number Of Medicare Beneficiaries | 2250 |
| Total Submitted Charge Amount | 834017.58 |
| Total Medicare Allowed Amount | 165389.24 |
| Total Medicare Payment Amount | 126287.93 |
| Total Medicare Standardized Payment Amount | 128325.91 |
| 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 | 281 |
| Number Of Medical Services | 3878 |
| Number Of Medicare Beneficiaries With Medical Services | 2250 |
| Total Medical Submitted Charge Amount | 834017.58 |
| Total Medical Medicare Allowed Amount | 165389.24 |
| Total Medical Medicare Payment Amount | 126287.93 |
| Total Medical Medicare Standardized Payment Amount | 128325.91 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 493 |
| Number Of Beneficiaries Age 65 to 74 | 720 |
| Number Of Beneficiaries Age 75 to 84 | 666 |
| Number Of Beneficiaries Age Greater 84 | 371 |
| Number Of Female Beneficiaries | 1337 |
| Number Of Male Beneficiaries | 913 |
| Number Of Non Hispanic White Beneficiaries | 2050 |
| Number Of Black or African American Beneficiaries | 114 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 33 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 33 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1417 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 833 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 38 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.9311 |