| National Provider Identifier [NPI]: | 1356587125 |
| Last Name Of The Provider | SOUZA |
| First Name Of The Provider | FREDERICO |
| 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 | 2500 N STATE ST |
| Street Address 2 Of The Provider | DEPT OF RADIOLOGY |
| City Of The Provider | JACKSON |
| Zip Code Of The Provider | 392164500 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 76 |
| Number Of Services | 3470 |
| Number Of Medicare Beneficiaries | 2110 |
| Total Submitted Charge Amount | 446858 |
| Total Medicare Allowed Amount | 119921.63 |
| Total Medicare Payment Amount | 92208.91 |
| Total Medicare Standardized Payment Amount | 97632.35 |
| 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 | 76 |
| Number Of Medical Services | 3470 |
| Number Of Medicare Beneficiaries With Medical Services | 2110 |
| Total Medical Submitted Charge Amount | 446858 |
| Total Medical Medicare Allowed Amount | 119921.63 |
| Total Medical Medicare Payment Amount | 92208.91 |
| Total Medical Medicare Standardized Payment Amount | 97632.35 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 809 |
| Number Of Beneficiaries Age 65 to 74 | 688 |
| Number Of Beneficiaries Age 75 to 84 | 411 |
| Number Of Beneficiaries Age Greater 84 | 202 |
| Number Of Female Beneficiaries | 1131 |
| Number Of Male Beneficiaries | 979 |
| Number Of Non Hispanic White Beneficiaries | 1122 |
| Number Of Black or African American Beneficiaries | 956 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1018 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1092 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.2374 |