| National Provider Identifier [NPI]: | 1043214497 |
| Last Name Of The Provider | GRANT |
| First Name Of The Provider | SHAWN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1120 S UTICA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | TULSA |
| Zip Code Of The Provider | 741044012 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 207 |
| Number Of Services | 9596 |
| Number Of Medicare Beneficiaries | 5118 |
| Total Submitted Charge Amount | 1018057 |
| Total Medicare Allowed Amount | 262995.94 |
| Total Medicare Payment Amount | 190383.56 |
| Total Medicare Standardized Payment Amount | 202089.81 |
| 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 | 207 |
| Number Of Medical Services | 9596 |
| Number Of Medicare Beneficiaries With Medical Services | 5118 |
| Total Medical Submitted Charge Amount | 1018057 |
| Total Medical Medicare Allowed Amount | 262995.94 |
| Total Medical Medicare Payment Amount | 190383.56 |
| Total Medical Medicare Standardized Payment Amount | 202089.81 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 1311 |
| Number Of Beneficiaries Age 65 to 74 | 1969 |
| Number Of Beneficiaries Age 75 to 84 | 1300 |
| Number Of Beneficiaries Age Greater 84 | 538 |
| Number Of Female Beneficiaries | 2948 |
| Number Of Male Beneficiaries | 2170 |
| Number Of Non Hispanic White Beneficiaries | 3812 |
| Number Of Black or African American Beneficiaries | 535 |
| Number Of AsianPacific Islander Beneficiaries | 24 |
| Number Of Hispanic Beneficiaries | 74 |
| Number Of American Indian Alaska Native Beneficiaries | 647 |
| Number Of Beneficiaries With Race Not Else where Classified | 26 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3352 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1766 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.6666 |