| National Provider Identifier [NPI]: | 1790700128 |
| Last Name Of The Provider | GRANT |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1970 ROANOKE BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SALEM |
| Zip Code Of The Provider | 241536404 |
| 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 | 161 |
| Number Of Services | 8053 |
| Number Of Medicare Beneficiaries | 3177 |
| Total Submitted Charge Amount | 693858.97 |
| Total Medicare Allowed Amount | 184349.42 |
| Total Medicare Payment Amount | 137388.33 |
| Total Medicare Standardized Payment Amount | 142709.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 2802 |
| Number Of Medicare Beneficiaries With Drug Services | 40 |
| Total Drug Submitted ChargeAmount | 4778 |
| Total Drug Medicare AllowedAmount | 748.3 |
| Total Drug Medicare PaymentAmount | 564.98 |
| Total Drug Medicare Standardized Payment Amount | 564.98 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 159 |
| Number Of Medical Services | 5251 |
| Number Of Medicare Beneficiaries With Medical Services | 3177 |
| Total Medical Submitted Charge Amount | 689080.97 |
| Total Medical Medicare Allowed Amount | 183601.12 |
| Total Medical Medicare Payment Amount | 136823.35 |
| Total Medical Medicare Standardized Payment Amount | 142144.1 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 526 |
| Number Of Beneficiaries Age 65 to 74 | 1079 |
| Number Of Beneficiaries Age 75 to 84 | 936 |
| Number Of Beneficiaries Age Greater 84 | 636 |
| Number Of Female Beneficiaries | 1983 |
| Number Of Male Beneficiaries | 1194 |
| Number Of Non Hispanic White Beneficiaries | 2834 |
| Number Of Black or African American Beneficiaries | 277 |
| Number Of AsianPacific Islander Beneficiaries | 19 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 27 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2494 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 683 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.5638 |