| National Provider Identifier [NPI]: | 1447342886 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11 WILLOW LAKE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | WARNER ROBINS |
| Zip Code Of The Provider | 310938523 |
| 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 | 72 |
| Number Of Services | 11530 |
| Number Of Medicare Beneficiaries | 5040 |
| Total Submitted Charge Amount | 860282.9 |
| Total Medicare Allowed Amount | 425375.61 |
| Total Medicare Payment Amount | 327765.31 |
| Total Medicare Standardized Payment Amount | 342708.81 |
| 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 | 72 |
| Number Of Medical Services | 11530 |
| Number Of Medicare Beneficiaries With Medical Services | 5040 |
| Total Medical Submitted Charge Amount | 860282.9 |
| Total Medical Medicare Allowed Amount | 425375.61 |
| Total Medical Medicare Payment Amount | 327765.31 |
| Total Medical Medicare Standardized Payment Amount | 342708.81 |
| Average Age Of Beneficiaries | 80 |
| Number Of Beneficiaries Age Less65 | 377 |
| Number Of Beneficiaries Age 65 to 74 | 949 |
| Number Of Beneficiaries Age 75 to 84 | 1664 |
| Number Of Beneficiaries Age Greater 84 | 2050 |
| Number Of Female Beneficiaries | 3271 |
| Number Of Male Beneficiaries | 1769 |
| Number Of Non Hispanic White Beneficiaries | 4198 |
| Number Of Black or African American Beneficiaries | 420 |
| Number Of AsianPacific Islander Beneficiaries | 39 |
| Number Of Hispanic Beneficiaries | 346 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2761 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 2279 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 61 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 54 |
| Percent Of With Chronic Kidney Disease | 52 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 49 |
| Percent Of With Depression | 59 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 64 |
| Percent Of With Osteoporosis | 20 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 62 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 17 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.2486 |