| National Provider Identifier [NPI]: | 1154546125 |
| Last Name Of The Provider | WEBBER |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1000 MONTAUK HWY |
| Street Address 2 Of The Provider | DEPARTMENT OF RADIOLOGY, GOOD SAMARITAN HOSPITAL |
| City Of The Provider | WEST ISLIP |
| Zip Code Of The Provider | 117954927 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 130 |
| Number Of Services | 7508 |
| Number Of Medicare Beneficiaries | 4140 |
| Total Submitted Charge Amount | 826825 |
| Total Medicare Allowed Amount | 233846.21 |
| Total Medicare Payment Amount | 179645.03 |
| Total Medicare Standardized Payment Amount | 163289.36 |
| 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 | 130 |
| Number Of Medical Services | 7508 |
| Number Of Medicare Beneficiaries With Medical Services | 4140 |
| Total Medical Submitted Charge Amount | 826825 |
| Total Medical Medicare Allowed Amount | 233846.21 |
| Total Medical Medicare Payment Amount | 179645.03 |
| Total Medical Medicare Standardized Payment Amount | 163289.36 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 585 |
| Number Of Beneficiaries Age 65 to 74 | 1107 |
| Number Of Beneficiaries Age 75 to 84 | 1337 |
| Number Of Beneficiaries Age Greater 84 | 1111 |
| Number Of Female Beneficiaries | 2410 |
| Number Of Male Beneficiaries | 1730 |
| Number Of Non Hispanic White Beneficiaries | 3511 |
| Number Of Black or African American Beneficiaries | 319 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 209 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 65 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2896 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1244 |
| Percent Of With Atrial Fibrillation | 28 |
| Percent Of With Alzheimers Disease or Dementia | 31 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 52 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 68 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 2.1308 |