| National Provider Identifier [NPI]: | 1952393464 |
| Last Name Of The Provider | THEOBALD |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1441 RIDGE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | NAPLES |
| Zip Code Of The Provider | 341034211 |
| 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 | 127 |
| Number Of Services | 46035 |
| Number Of Medicare Beneficiaries | 4027 |
| Total Submitted Charge Amount | 1657479.85 |
| Total Medicare Allowed Amount | 767552.02 |
| Total Medicare Payment Amount | 587341.51 |
| Total Medicare Standardized Payment Amount | 573692.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 40544 |
| Number Of Medicare Beneficiaries With Drug Services | 572 |
| Total Drug Submitted ChargeAmount | 41936.45 |
| Total Drug Medicare AllowedAmount | 14228.51 |
| Total Drug Medicare PaymentAmount | 11095.57 |
| Total Drug Medicare Standardized Payment Amount | 11095.57 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 124 |
| Number Of Medical Services | 5491 |
| Number Of Medicare Beneficiaries With Medical Services | 4015 |
| Total Medical Submitted Charge Amount | 1615543.4 |
| Total Medical Medicare Allowed Amount | 753323.51 |
| Total Medical Medicare Payment Amount | 576245.94 |
| Total Medical Medicare Standardized Payment Amount | 562597.11 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 226 |
| Number Of Beneficiaries Age 65 to 74 | 1600 |
| Number Of Beneficiaries Age 75 to 84 | 1529 |
| Number Of Beneficiaries Age Greater 84 | 672 |
| Number Of Female Beneficiaries | 2216 |
| Number Of Male Beneficiaries | 1811 |
| Number Of Non Hispanic White Beneficiaries | 3692 |
| Number Of Black or African American Beneficiaries | 46 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 216 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 49 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3661 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 366 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.2944 |