| National Provider Identifier [NPI]: | 1275604621 |
| Last Name Of The Provider | PUTNAM |
| First Name Of The Provider | WAYNE |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3125 DR RUSSELL SMITH WAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | CARTHAGE |
| Zip Code Of The Provider | 648367402 |
| 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 | 174 |
| Number Of Services | 7544 |
| Number Of Medicare Beneficiaries | 3253 |
| Total Submitted Charge Amount | 695209 |
| Total Medicare Allowed Amount | 203368.53 |
| Total Medicare Payment Amount | 152997.91 |
| Total Medicare Standardized Payment Amount | 161236.47 |
| 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 | 174 |
| Number Of Medical Services | 7544 |
| Number Of Medicare Beneficiaries With Medical Services | 3253 |
| Total Medical Submitted Charge Amount | 695209 |
| Total Medical Medicare Allowed Amount | 203368.53 |
| Total Medical Medicare Payment Amount | 152997.91 |
| Total Medical Medicare Standardized Payment Amount | 161236.47 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 637 |
| Number Of Beneficiaries Age 65 to 74 | 1218 |
| Number Of Beneficiaries Age 75 to 84 | 943 |
| Number Of Beneficiaries Age Greater 84 | 455 |
| Number Of Female Beneficiaries | 2162 |
| Number Of Male Beneficiaries | 1091 |
| Number Of Non Hispanic White Beneficiaries | 3101 |
| Number Of Black or African American Beneficiaries | 43 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 38 |
| Number Of American Indian Alaska Native Beneficiaries | 35 |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2461 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 792 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2777 |