| National Provider Identifier [NPI]: | 1497807531 |
| Last Name Of The Provider | FORMAN |
| First Name Of The Provider | WALTER |
| Middle Initial Of The Provider | H |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 733 US HIGHWAY 1 BLDG 2B |
| Street Address 2 Of The Provider | |
| City Of The Provider | NORTH PALM BEACH |
| Zip Code Of The Provider | 334084513 |
| 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 | 155 |
| Number Of Services | 38933.5 |
| Number Of Medicare Beneficiaries | 3371 |
| Total Submitted Charge Amount | 3221333.99 |
| Total Medicare Allowed Amount | 828774.53 |
| Total Medicare Payment Amount | 650170.54 |
| Total Medicare Standardized Payment Amount | 625739.34 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 32240.5 |
| Number Of Medicare Beneficiaries With Drug Services | 475 |
| Total Drug Submitted ChargeAmount | 38374.99 |
| Total Drug Medicare AllowedAmount | 11185.25 |
| Total Drug Medicare PaymentAmount | 8752.4 |
| Total Drug Medicare Standardized Payment Amount | 8752.4 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 150 |
| Number Of Medical Services | 6693 |
| Number Of Medicare Beneficiaries With Medical Services | 3370 |
| Total Medical Submitted Charge Amount | 3182959 |
| Total Medical Medicare Allowed Amount | 817589.28 |
| Total Medical Medicare Payment Amount | 641418.14 |
| Total Medical Medicare Standardized Payment Amount | 616986.94 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 159 |
| Number Of Beneficiaries Age 65 to 74 | 1624 |
| Number Of Beneficiaries Age 75 to 84 | 1166 |
| Number Of Beneficiaries Age Greater 84 | 422 |
| Number Of Female Beneficiaries | 2262 |
| Number Of Male Beneficiaries | 1109 |
| Number Of Non Hispanic White Beneficiaries | 3115 |
| Number Of Black or African American Beneficiaries | 111 |
| Number Of AsianPacific Islander Beneficiaries | 25 |
| Number Of Hispanic Beneficiaries | 59 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 61 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3236 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 135 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0533 |