| National Provider Identifier [NPI]: | 1104879360 |
| Last Name Of The Provider | LOCKWOOD |
| First Name Of The Provider | MARIBEL |
| Middle Initial Of The Provider | U |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1600 PHILLIPS RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | TALLAHASSEE |
| Zip Code Of The Provider | 323085304 |
| 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 | 126 |
| Number Of Services | 5689 |
| Number Of Medicare Beneficiaries | 2604 |
| Total Submitted Charge Amount | 834470 |
| Total Medicare Allowed Amount | 344097.51 |
| Total Medicare Payment Amount | 294658.53 |
| Total Medicare Standardized Payment Amount | 300946.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 722 |
| Number Of Medicare Beneficiaries With Drug Services | 40 |
| Total Drug Submitted ChargeAmount | 6500 |
| Total Drug Medicare AllowedAmount | 1444.85 |
| Total Drug Medicare PaymentAmount | 1132.83 |
| Total Drug Medicare Standardized Payment Amount | 1132.83 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 124 |
| Number Of Medical Services | 4967 |
| Number Of Medicare Beneficiaries With Medical Services | 2604 |
| Total Medical Submitted Charge Amount | 827970 |
| Total Medical Medicare Allowed Amount | 342652.66 |
| Total Medical Medicare Payment Amount | 293525.7 |
| Total Medical Medicare Standardized Payment Amount | 299814.16 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 495 |
| Number Of Beneficiaries Age 65 to 74 | 1034 |
| Number Of Beneficiaries Age 75 to 84 | 790 |
| Number Of Beneficiaries Age Greater 84 | 285 |
| Number Of Female Beneficiaries | 2141 |
| Number Of Male Beneficiaries | 463 |
| Number Of Non Hispanic White Beneficiaries | 1849 |
| Number Of Black or African American Beneficiaries | 691 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 36 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1905 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 699 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.2563 |