| National Provider Identifier [NPI]: | 1740271824 |
| Last Name Of The Provider | BRIDGES |
| First Name Of The Provider | MELLENA |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| 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 | 49 |
| Number Of Services | 110130 |
| Number Of Medicare Beneficiaries | 1602 |
| Total Submitted Charge Amount | 999378.5 |
| Total Medicare Allowed Amount | 701184.71 |
| Total Medicare Payment Amount | 520403.81 |
| Total Medicare Standardized Payment Amount | 573946.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 108743 |
| Number Of Medicare Beneficiaries With Drug Services | 1485 |
| Total Drug Submitted ChargeAmount | 349922.56 |
| Total Drug Medicare AllowedAmount | 291438.71 |
| Total Drug Medicare PaymentAmount | 208869.18 |
| Total Drug Medicare Standardized Payment Amount | 208869.18 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 1387 |
| Number Of Medicare Beneficiaries With Medical Services | 863 |
| Total Medical Submitted Charge Amount | 649455.94 |
| Total Medical Medicare Allowed Amount | 409746 |
| Total Medical Medicare Payment Amount | 311534.63 |
| Total Medical Medicare Standardized Payment Amount | 365077.54 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 283 |
| Number Of Beneficiaries Age 65 to 74 | 768 |
| Number Of Beneficiaries Age 75 to 84 | 471 |
| Number Of Beneficiaries Age Greater 84 | 80 |
| Number Of Female Beneficiaries | 820 |
| Number Of Male Beneficiaries | 782 |
| Number Of Non Hispanic White Beneficiaries | 1409 |
| Number Of Black or African American Beneficiaries | 96 |
| Number Of AsianPacific Islander Beneficiaries | 22 |
| Number Of Hispanic Beneficiaries | 54 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1460 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 142 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.7085 |