| National Provider Identifier [NPI]: | 1194713867 |
| Last Name Of The Provider | CUBBERLEY |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 489 STATE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BANGOR |
| Zip Code Of The Provider | 044016616 |
| State Code Of The Provider | ME |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 211 |
| Number Of Services | 6857 |
| Number Of Medicare Beneficiaries | 4644 |
| Total Submitted Charge Amount | 1196986 |
| Total Medicare Allowed Amount | 202368.2 |
| Total Medicare Payment Amount | 153431.4 |
| Total Medicare Standardized Payment Amount | 161343.71 |
| 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 | 211 |
| Number Of Medical Services | 6857 |
| Number Of Medicare Beneficiaries With Medical Services | 4644 |
| Total Medical Submitted Charge Amount | 1196986 |
| Total Medical Medicare Allowed Amount | 202368.2 |
| Total Medical Medicare Payment Amount | 153431.4 |
| Total Medical Medicare Standardized Payment Amount | 161343.71 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 1223 |
| Number Of Beneficiaries Age 65 to 74 | 1598 |
| Number Of Beneficiaries Age 75 to 84 | 1225 |
| Number Of Beneficiaries Age Greater 84 | 598 |
| Number Of Female Beneficiaries | 2742 |
| Number Of Male Beneficiaries | 1902 |
| Number Of Non Hispanic White Beneficiaries | 4504 |
| Number Of Black or African American Beneficiaries | 16 |
| Number Of AsianPacific Islander Beneficiaries | 17 |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | 38 |
| Number Of Beneficiaries With Race Not Else where Classified | 42 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2320 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 2324 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5147 |