| National Provider Identifier [NPI]: | 1396710067 |
| Last Name Of The Provider | ALLEN |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3950 AUSTELL RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | AUSTELL |
| Zip Code Of The Provider | 301061121 |
| 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 | 148 |
| Number Of Services | 4635 |
| Number Of Medicare Beneficiaries | 2292 |
| Total Submitted Charge Amount | 627492 |
| Total Medicare Allowed Amount | 143685.63 |
| Total Medicare Payment Amount | 109202.05 |
| Total Medicare Standardized Payment Amount | 114894.6 |
| 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 | 148 |
| Number Of Medical Services | 4635 |
| Number Of Medicare Beneficiaries With Medical Services | 2292 |
| Total Medical Submitted Charge Amount | 627492 |
| Total Medical Medicare Allowed Amount | 143685.63 |
| Total Medical Medicare Payment Amount | 109202.05 |
| Total Medical Medicare Standardized Payment Amount | 114894.6 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 571 |
| Number Of Beneficiaries Age 65 to 74 | 739 |
| Number Of Beneficiaries Age 75 to 84 | 613 |
| Number Of Beneficiaries Age Greater 84 | 369 |
| Number Of Female Beneficiaries | 1249 |
| Number Of Male Beneficiaries | 1043 |
| Number Of Non Hispanic White Beneficiaries | 1590 |
| Number Of Black or African American Beneficiaries | 673 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1391 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 901 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.0546 |