| National Provider Identifier [NPI]: | 1023086501 |
| Last Name Of The Provider | LEE |
| First Name Of The Provider | JUSTIN |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2700 UNIVERSITY SQUARE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | TAMPA |
| Zip Code Of The Provider | 336125513 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 283 |
| Number Of Services | 5075 |
| Number Of Medicare Beneficiaries | 1645 |
| Total Submitted Charge Amount | 1331208 |
| Total Medicare Allowed Amount | 334946.72 |
| Total Medicare Payment Amount | 261084.31 |
| Total Medicare Standardized Payment Amount | 257298.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 1170 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 1420 |
| Total Drug Medicare AllowedAmount | 228.34 |
| Total Drug Medicare PaymentAmount | 168.82 |
| Total Drug Medicare Standardized Payment Amount | 168.82 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 282 |
| Number Of Medical Services | 3905 |
| Number Of Medicare Beneficiaries With Medical Services | 1644 |
| Total Medical Submitted Charge Amount | 1329788 |
| Total Medical Medicare Allowed Amount | 334718.38 |
| Total Medical Medicare Payment Amount | 260915.49 |
| Total Medical Medicare Standardized Payment Amount | 257129.26 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 157 |
| Number Of Beneficiaries Age 65 to 74 | 592 |
| Number Of Beneficiaries Age 75 to 84 | 557 |
| Number Of Beneficiaries Age Greater 84 | 339 |
| Number Of Female Beneficiaries | 848 |
| Number Of Male Beneficiaries | 797 |
| Number Of Non Hispanic White Beneficiaries | 1513 |
| Number Of Black or African American Beneficiaries | 74 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 37 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1398 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 247 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 25 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.0502 |