| National Provider Identifier [NPI]: | 1043244684 |
| Last Name Of The Provider | HUMPHREY |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 315 N. WASHINGTON AVENUE, SUITE 103 |
| Street Address 2 Of The Provider | |
| City Of The Provider | COOKEVILLE |
| Zip Code Of The Provider | 38501 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 172 |
| Number Of Services | 16884 |
| Number Of Medicare Beneficiaries | 2303 |
| Total Submitted Charge Amount | 1254543.64 |
| Total Medicare Allowed Amount | 372801.84 |
| Total Medicare Payment Amount | 296476.57 |
| Total Medicare Standardized Payment Amount | 331091.8 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 12525 |
| Number Of Medicare Beneficiaries With Drug Services | 173 |
| Total Drug Submitted ChargeAmount | 6437.46 |
| Total Drug Medicare AllowedAmount | 5504.69 |
| Total Drug Medicare PaymentAmount | 4301.71 |
| Total Drug Medicare Standardized Payment Amount | 4301.71 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 165 |
| Number Of Medical Services | 4359 |
| Number Of Medicare Beneficiaries With Medical Services | 2303 |
| Total Medical Submitted Charge Amount | 1248106.18 |
| Total Medical Medicare Allowed Amount | 367297.15 |
| Total Medical Medicare Payment Amount | 292174.86 |
| Total Medical Medicare Standardized Payment Amount | 326790.09 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 494 |
| Number Of Beneficiaries Age 65 to 74 | 1108 |
| Number Of Beneficiaries Age 75 to 84 | 553 |
| Number Of Beneficiaries Age Greater 84 | 148 |
| Number Of Female Beneficiaries | 1639 |
| Number Of Male Beneficiaries | 664 |
| Number Of Non Hispanic White Beneficiaries | 2260 |
| Number Of Black or African American Beneficiaries | 12 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1713 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 590 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0863 |