| National Provider Identifier [NPI]: | 1922024983 |
| Last Name Of The Provider | HENRY |
| First Name Of The Provider | TRAVIS |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 510 S KINGSHIGHWAY BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAINT LOUIS |
| Zip Code Of The Provider | 631101016 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 7618 |
| Number Of Medicare Beneficiaries | 5063 |
| Total Submitted Charge Amount | 527271 |
| Total Medicare Allowed Amount | 170736.88 |
| Total Medicare Payment Amount | 128641.07 |
| Total Medicare Standardized Payment Amount | 133103.58 |
| 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 | 27 |
| Number Of Medical Services | 7618 |
| Number Of Medicare Beneficiaries With Medical Services | 5063 |
| Total Medical Submitted Charge Amount | 527271 |
| Total Medical Medicare Allowed Amount | 170736.88 |
| Total Medical Medicare Payment Amount | 128641.07 |
| Total Medical Medicare Standardized Payment Amount | 133103.58 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 1185 |
| Number Of Beneficiaries Age 65 to 74 | 1922 |
| Number Of Beneficiaries Age 75 to 84 | 1322 |
| Number Of Beneficiaries Age Greater 84 | 634 |
| Number Of Female Beneficiaries | 2406 |
| Number Of Male Beneficiaries | 2657 |
| Number Of Non Hispanic White Beneficiaries | 3047 |
| Number Of Black or African American Beneficiaries | 1811 |
| Number Of AsianPacific Islander Beneficiaries | 77 |
| Number Of Hispanic Beneficiaries | 71 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 3693 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1370 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 47 |
| Percent Of With Chronic Kidney Disease | 54 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.4712 |