| National Provider Identifier [NPI]: | 1730156498 |
| Last Name Of The Provider | OVELLA |
| First Name Of The Provider | TY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1202 S TYLER ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | COVINGTON |
| Zip Code Of The Provider | 704332330 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 177 |
| Number Of Services | 4772 |
| Number Of Medicare Beneficiaries | 2901 |
| Total Submitted Charge Amount | 179584 |
| Total Medicare Allowed Amount | 114838.33 |
| Total Medicare Payment Amount | 88437.03 |
| Total Medicare Standardized Payment Amount | 94040.38 |
| 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 | 177 |
| Number Of Medical Services | 4772 |
| Number Of Medicare Beneficiaries With Medical Services | 2901 |
| Total Medical Submitted Charge Amount | 179584 |
| Total Medical Medicare Allowed Amount | 114838.33 |
| Total Medical Medicare Payment Amount | 88437.03 |
| Total Medical Medicare Standardized Payment Amount | 94040.38 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 683 |
| Number Of Beneficiaries Age 65 to 74 | 1084 |
| Number Of Beneficiaries Age 75 to 84 | 746 |
| Number Of Beneficiaries Age Greater 84 | 388 |
| Number Of Female Beneficiaries | 1875 |
| Number Of Male Beneficiaries | 1026 |
| Number Of Non Hispanic White Beneficiaries | 2229 |
| Number Of Black or African American Beneficiaries | 598 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 44 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1784 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1117 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.8114 |