| National Provider Identifier [NPI]: | 1457551343 |
| Last Name Of The Provider | LEMOINE |
| First Name Of The Provider | NICHOLAS |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2500 N STATE ST |
| Street Address 2 Of The Provider | DEPT OF RADIOLOGY |
| City Of The Provider | JACKSON |
| Zip Code Of The Provider | 392164500 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 168 |
| Number Of Services | 4666 |
| Number Of Medicare Beneficiaries | 3004 |
| Total Submitted Charge Amount | 432762 |
| Total Medicare Allowed Amount | 109479.08 |
| Total Medicare Payment Amount | 82162.58 |
| Total Medicare Standardized Payment Amount | 85790.04 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 168 |
| Number Of Medical Services | 4666 |
| Number Of Medicare Beneficiaries With Medical Services | 3004 |
| Total Medical Submitted Charge Amount | 432762 |
| Total Medical Medicare Allowed Amount | 109479.08 |
| Total Medical Medicare Payment Amount | 82162.58 |
| Total Medical Medicare Standardized Payment Amount | 85790.04 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 742 |
| Number Of Beneficiaries Age 65 to 74 | 1069 |
| Number Of Beneficiaries Age 75 to 84 | 794 |
| Number Of Beneficiaries Age Greater 84 | 399 |
| Number Of Female Beneficiaries | 1818 |
| Number Of Male Beneficiaries | 1186 |
| Number Of Non Hispanic White Beneficiaries | 2089 |
| Number Of Black or African American Beneficiaries | 812 |
| Number Of AsianPacific Islander Beneficiaries | 25 |
| Number Of Hispanic Beneficiaries | 61 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1738 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1266 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.7203 |