| National Provider Identifier [NPI]: | 1285729657 |
| Last Name Of The Provider | HILLEN |
| First Name Of The Provider | TRAVIS |
| 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 | 510 S KINGSHIGHWAY BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAINT LOUIS |
| Zip Code Of The Provider | 631101016 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 133 |
| Number Of Services | 4532 |
| Number Of Medicare Beneficiaries | 2795 |
| Total Submitted Charge Amount | 421305 |
| Total Medicare Allowed Amount | 92811.49 |
| Total Medicare Payment Amount | 71056.88 |
| Total Medicare Standardized Payment Amount | 71333.81 |
| 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 | 133 |
| Number Of Medical Services | 4532 |
| Number Of Medicare Beneficiaries With Medical Services | 2795 |
| Total Medical Submitted Charge Amount | 421305 |
| Total Medical Medicare Allowed Amount | 92811.49 |
| Total Medical Medicare Payment Amount | 71056.88 |
| Total Medical Medicare Standardized Payment Amount | 71333.81 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 794 |
| Number Of Beneficiaries Age 65 to 74 | 1188 |
| Number Of Beneficiaries Age 75 to 84 | 598 |
| Number Of Beneficiaries Age Greater 84 | 215 |
| Number Of Female Beneficiaries | 1644 |
| Number Of Male Beneficiaries | 1151 |
| Number Of Non Hispanic White Beneficiaries | 2143 |
| Number Of Black or African American Beneficiaries | 561 |
| Number Of AsianPacific Islander Beneficiaries | 26 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 43 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2112 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 683 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.6878 |