| National Provider Identifier [NPI]: | 1992923155 |
| Last Name Of The Provider | POWERS |
| First Name Of The Provider | KELLY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 593 EDDY ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PROVIDENCE |
| Zip Code Of The Provider | 029034923 |
| State Code Of The Provider | RI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 158 |
| Number Of Services | 29686 |
| Number Of Medicare Beneficiaries | 4398 |
| Total Submitted Charge Amount | 2524192 |
| Total Medicare Allowed Amount | 603452.12 |
| Total Medicare Payment Amount | 487472 |
| Total Medicare Standardized Payment Amount | 414355.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 22497 |
| Number Of Medicare Beneficiaries With Drug Services | 193 |
| Total Drug Submitted ChargeAmount | 24865 |
| Total Drug Medicare AllowedAmount | 6542.6 |
| Total Drug Medicare PaymentAmount | 5129.29 |
| Total Drug Medicare Standardized Payment Amount | 5129.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 155 |
| Number Of Medical Services | 7189 |
| Number Of Medicare Beneficiaries With Medical Services | 4398 |
| Total Medical Submitted Charge Amount | 2499327 |
| Total Medical Medicare Allowed Amount | 596909.52 |
| Total Medical Medicare Payment Amount | 482342.71 |
| Total Medical Medicare Standardized Payment Amount | 409226 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 609 |
| Number Of Beneficiaries Age 65 to 74 | 2349 |
| Number Of Beneficiaries Age 75 to 84 | 1155 |
| Number Of Beneficiaries Age Greater 84 | 285 |
| Number Of Female Beneficiaries | 3259 |
| Number Of Male Beneficiaries | 1139 |
| Number Of Non Hispanic White Beneficiaries | 3670 |
| Number Of Black or African American Beneficiaries | 142 |
| Number Of AsianPacific Islander Beneficiaries | 263 |
| Number Of Hispanic Beneficiaries | 149 |
| Number Of American Indian Alaska Native Beneficiaries | 82 |
| Number Of Beneficiaries With Race Not Else where Classified | 92 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3352 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1046 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0349 |