| National Provider Identifier [NPI]: | 1114001252 |
| Last Name Of The Provider | COTTRELL |
| First Name Of The Provider | JEFFREY |
| 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 | 4516 N ARMENIA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | TAMPA |
| Zip Code Of The Provider | 336032732 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 151 |
| Number Of Services | 10278 |
| Number Of Medicare Beneficiaries | 2457 |
| Total Submitted Charge Amount | 687791.6 |
| Total Medicare Allowed Amount | 175615.69 |
| Total Medicare Payment Amount | 134144.32 |
| Total Medicare Standardized Payment Amount | 137634.57 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 7095 |
| Number Of Medicare Beneficiaries With Drug Services | 76 |
| Total Drug Submitted ChargeAmount | 18099.6 |
| Total Drug Medicare AllowedAmount | 1643.14 |
| Total Drug Medicare PaymentAmount | 1288.16 |
| Total Drug Medicare Standardized Payment Amount | 1288.16 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 149 |
| Number Of Medical Services | 3183 |
| Number Of Medicare Beneficiaries With Medical Services | 2455 |
| Total Medical Submitted Charge Amount | 669692 |
| Total Medical Medicare Allowed Amount | 173972.55 |
| Total Medical Medicare Payment Amount | 132856.16 |
| Total Medical Medicare Standardized Payment Amount | 136346.41 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 414 |
| Number Of Beneficiaries Age 65 to 74 | 830 |
| Number Of Beneficiaries Age 75 to 84 | 726 |
| Number Of Beneficiaries Age Greater 84 | 487 |
| Number Of Female Beneficiaries | 1502 |
| Number Of Male Beneficiaries | 955 |
| Number Of Non Hispanic White Beneficiaries | 1611 |
| Number Of Black or African American Beneficiaries | 295 |
| Number Of AsianPacific Islander Beneficiaries | 32 |
| Number Of Hispanic Beneficiaries | 498 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1633 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 824 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 28 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 1.9489 |