| National Provider Identifier [NPI]: | 1770527103 |
| Last Name Of The Provider | LONG |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1906 BELLEVIEW AVE SE |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROANOKE |
| Zip Code Of The Provider | 240141838 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 146 |
| Number Of Services | 8794 |
| Number Of Medicare Beneficiaries | 3908 |
| Total Submitted Charge Amount | 688586.74 |
| Total Medicare Allowed Amount | 195125.93 |
| Total Medicare Payment Amount | 160277.04 |
| Total Medicare Standardized Payment Amount | 164606.41 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1462 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 2593 |
| Total Drug Medicare AllowedAmount | 415.68 |
| Total Drug Medicare PaymentAmount | 277.1 |
| Total Drug Medicare Standardized Payment Amount | 277.1 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 144 |
| Number Of Medical Services | 7332 |
| Number Of Medicare Beneficiaries With Medical Services | 3908 |
| Total Medical Submitted Charge Amount | 685993.74 |
| Total Medical Medicare Allowed Amount | 194710.25 |
| Total Medical Medicare Payment Amount | 159999.94 |
| Total Medical Medicare Standardized Payment Amount | 164329.31 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 551 |
| Number Of Beneficiaries Age 65 to 74 | 1554 |
| Number Of Beneficiaries Age 75 to 84 | 1184 |
| Number Of Beneficiaries Age Greater 84 | 619 |
| Number Of Female Beneficiaries | 2898 |
| Number Of Male Beneficiaries | 1010 |
| Number Of Non Hispanic White Beneficiaries | 3550 |
| Number Of Black or African American Beneficiaries | 296 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3228 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 680 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3115 |