| National Provider Identifier [NPI]: | 1609894708 |
| Last Name Of The Provider | WILLOUGHBY |
| First Name Of The Provider | WILLIAM |
| 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 | 821 N COBB ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MILLEDGEVILLE |
| Zip Code Of The Provider | 310612343 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 196 |
| Number Of Services | 8410 |
| Number Of Medicare Beneficiaries | 2939 |
| Total Submitted Charge Amount | 837690.8 |
| Total Medicare Allowed Amount | 206964.32 |
| Total Medicare Payment Amount | 151742.44 |
| Total Medicare Standardized Payment Amount | 162155.89 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 2229 |
| Number Of Medicare Beneficiaries With Drug Services | 37 |
| Total Drug Submitted ChargeAmount | 9530 |
| Total Drug Medicare AllowedAmount | 970.97 |
| Total Drug Medicare PaymentAmount | 761.25 |
| Total Drug Medicare Standardized Payment Amount | 761.25 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 193 |
| Number Of Medical Services | 6181 |
| Number Of Medicare Beneficiaries With Medical Services | 2939 |
| Total Medical Submitted Charge Amount | 828160.8 |
| Total Medical Medicare Allowed Amount | 205993.35 |
| Total Medical Medicare Payment Amount | 150981.19 |
| Total Medical Medicare Standardized Payment Amount | 161394.64 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 721 |
| Number Of Beneficiaries Age 65 to 74 | 1070 |
| Number Of Beneficiaries Age 75 to 84 | 760 |
| Number Of Beneficiaries Age Greater 84 | 388 |
| Number Of Female Beneficiaries | 1751 |
| Number Of Male Beneficiaries | 1188 |
| Number Of Non Hispanic White Beneficiaries | 2037 |
| Number Of Black or African American Beneficiaries | 868 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2052 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 887 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.5675 |