| National Provider Identifier [NPI]: | 1346231313 |
| Last Name Of The Provider | DALTON |
| First Name Of The Provider | JON |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4500 SAN PABLO RD S |
| Street Address 2 Of The Provider | |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322241865 |
| 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 | 100 |
| Number Of Services | 22329 |
| Number Of Medicare Beneficiaries | 1754 |
| Total Submitted Charge Amount | 438012.24 |
| Total Medicare Allowed Amount | 326244.82 |
| Total Medicare Payment Amount | 246549.38 |
| Total Medicare Standardized Payment Amount | 267779.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 19806 |
| Number Of Medicare Beneficiaries With Drug Services | 128 |
| Total Drug Submitted ChargeAmount | 5546.44 |
| Total Drug Medicare AllowedAmount | 3572.27 |
| Total Drug Medicare PaymentAmount | 2408.22 |
| Total Drug Medicare Standardized Payment Amount | 2408.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 97 |
| Number Of Medical Services | 2523 |
| Number Of Medicare Beneficiaries With Medical Services | 1754 |
| Total Medical Submitted Charge Amount | 432465.8 |
| Total Medical Medicare Allowed Amount | 322672.55 |
| Total Medical Medicare Payment Amount | 244141.16 |
| Total Medical Medicare Standardized Payment Amount | 265371.26 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 252 |
| Number Of Beneficiaries Age 65 to 74 | 740 |
| Number Of Beneficiaries Age 75 to 84 | 544 |
| Number Of Beneficiaries Age Greater 84 | 218 |
| Number Of Female Beneficiaries | 902 |
| Number Of Male Beneficiaries | 852 |
| Number Of Non Hispanic White Beneficiaries | 1539 |
| Number Of Black or African American Beneficiaries | 130 |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | 47 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 26 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1625 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 129 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.8253 |