| National Provider Identifier [NPI]: | 1508912403 |
| Last Name Of The Provider | MCCOY |
| First Name Of The Provider | JUSTIN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3330 NW 56TH |
| Street Address 2 Of The Provider | SUITE 206 |
| City Of The Provider | OKLA CITY |
| Zip Code Of The Provider | 731124426 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 177 |
| Number Of Services | 8065 |
| Number Of Medicare Beneficiaries | 3563 |
| Total Submitted Charge Amount | 279298.22 |
| Total Medicare Allowed Amount | 263059.79 |
| Total Medicare Payment Amount | 195389.82 |
| Total Medicare Standardized Payment Amount | 206117.44 |
| 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 | 177 |
| Number Of Medical Services | 8065 |
| Number Of Medicare Beneficiaries With Medical Services | 3563 |
| Total Medical Submitted Charge Amount | 279298.22 |
| Total Medical Medicare Allowed Amount | 263059.79 |
| Total Medical Medicare Payment Amount | 195389.82 |
| Total Medical Medicare Standardized Payment Amount | 206117.44 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 792 |
| Number Of Beneficiaries Age 65 to 74 | 1319 |
| Number Of Beneficiaries Age 75 to 84 | 994 |
| Number Of Beneficiaries Age Greater 84 | 458 |
| Number Of Female Beneficiaries | 2187 |
| Number Of Male Beneficiaries | 1376 |
| Number Of Non Hispanic White Beneficiaries | 3045 |
| Number Of Black or African American Beneficiaries | 83 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 39 |
| Number Of American Indian Alaska Native Beneficiaries | 370 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2424 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1139 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.5415 |