| National Provider Identifier [NPI]: | 1467691766 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| 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 | 247 |
| Number Of Services | 7864 |
| Number Of Medicare Beneficiaries | 2137 |
| Total Submitted Charge Amount | 923538 |
| Total Medicare Allowed Amount | 187952.14 |
| Total Medicare Payment Amount | 145042.41 |
| Total Medicare Standardized Payment Amount | 151777.04 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 3840 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 3930 |
| Total Drug Medicare AllowedAmount | 715.79 |
| Total Drug Medicare PaymentAmount | 561.12 |
| Total Drug Medicare Standardized Payment Amount | 561.12 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 245 |
| Number Of Medical Services | 4024 |
| Number Of Medicare Beneficiaries With Medical Services | 2137 |
| Total Medical Submitted Charge Amount | 919608 |
| Total Medical Medicare Allowed Amount | 187236.35 |
| Total Medical Medicare Payment Amount | 144481.29 |
| Total Medical Medicare Standardized Payment Amount | 151215.92 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 643 |
| Number Of Beneficiaries Age 65 to 74 | 708 |
| Number Of Beneficiaries Age 75 to 84 | 526 |
| Number Of Beneficiaries Age Greater 84 | 260 |
| Number Of Female Beneficiaries | 1248 |
| Number Of Male Beneficiaries | 889 |
| Number Of Non Hispanic White Beneficiaries | 1960 |
| Number Of Black or African American Beneficiaries | 133 |
| Number Of AsianPacific Islander Beneficiaries | 17 |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1304 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 833 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.557 |