| National Provider Identifier [NPI]: | 1336124825 |
| Last Name Of The Provider | GREENSPAN |
| First Name Of The Provider | STACY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | DO |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2912 CATHEDRAL PARK VW |
| Street Address 2 Of The Provider | |
| City Of The Provider | COLORADO SPRINGS |
| Zip Code Of The Provider | 809044722 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 124 |
| Number Of Services | 3532 |
| Number Of Medicare Beneficiaries | 1857 |
| Total Submitted Charge Amount | 549402.94 |
| Total Medicare Allowed Amount | 162326.95 |
| Total Medicare Payment Amount | 126728.66 |
| Total Medicare Standardized Payment Amount | 128468.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 802 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 2895 |
| Total Drug Medicare AllowedAmount | 696.9 |
| Total Drug Medicare PaymentAmount | 537.23 |
| Total Drug Medicare Standardized Payment Amount | 537.23 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 122 |
| Number Of Medical Services | 2730 |
| Number Of Medicare Beneficiaries With Medical Services | 1857 |
| Total Medical Submitted Charge Amount | 546507.94 |
| Total Medical Medicare Allowed Amount | 161630.05 |
| Total Medical Medicare Payment Amount | 126191.43 |
| Total Medical Medicare Standardized Payment Amount | 127931.15 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 279 |
| Number Of Beneficiaries Age 65 to 74 | 703 |
| Number Of Beneficiaries Age 75 to 84 | 556 |
| Number Of Beneficiaries Age Greater 84 | 319 |
| Number Of Female Beneficiaries | 1245 |
| Number Of Male Beneficiaries | 612 |
| Number Of Non Hispanic White Beneficiaries | 1620 |
| Number Of Black or African American Beneficiaries | 51 |
| Number Of AsianPacific Islander Beneficiaries | 32 |
| Number Of Hispanic Beneficiaries | 134 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1507 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 350 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.3774 |