| National Provider Identifier [NPI]: | 1215975719 |
| Last Name Of The Provider | CEBALLOS |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 13244 SW 7TH AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | NEWBERRY |
| Zip Code Of The Provider | 326693345 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 275 |
| Number Of Services | 11074 |
| Number Of Medicare Beneficiaries | 5440 |
| Total Submitted Charge Amount | 1282401 |
| Total Medicare Allowed Amount | 350071.97 |
| Total Medicare Payment Amount | 266738.04 |
| Total Medicare Standardized Payment Amount | 265690.82 |
| 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 | 275 |
| Number Of Medical Services | 11074 |
| Number Of Medicare Beneficiaries With Medical Services | 5440 |
| Total Medical Submitted Charge Amount | 1282401 |
| Total Medical Medicare Allowed Amount | 350071.97 |
| Total Medical Medicare Payment Amount | 266738.04 |
| Total Medical Medicare Standardized Payment Amount | 265690.82 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 609 |
| Number Of Beneficiaries Age 65 to 74 | 1918 |
| Number Of Beneficiaries Age 75 to 84 | 1934 |
| Number Of Beneficiaries Age Greater 84 | 979 |
| Number Of Female Beneficiaries | 3181 |
| Number Of Male Beneficiaries | 2259 |
| Number Of Non Hispanic White Beneficiaries | 5115 |
| Number Of Black or African American Beneficiaries | 87 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 129 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 63 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4515 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 925 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.4837 |