| National Provider Identifier [NPI]: | 1366403347 |
| Last Name Of The Provider | MONTGOMERY |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2401 S 31ST ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | TEMPLE |
| Zip Code Of The Provider | 765080001 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 158 |
| Number Of Services | 1471 |
| Number Of Medicare Beneficiaries | 671 |
| Total Submitted Charge Amount | 2184499 |
| Total Medicare Allowed Amount | 163706.69 |
| Total Medicare Payment Amount | 125607.42 |
| Total Medicare Standardized Payment Amount | 129390.79 |
| 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 | 158 |
| Number Of Medical Services | 1471 |
| Number Of Medicare Beneficiaries With Medical Services | 671 |
| Total Medical Submitted Charge Amount | 2184499 |
| Total Medical Medicare Allowed Amount | 163706.69 |
| Total Medical Medicare Payment Amount | 125607.42 |
| Total Medical Medicare Standardized Payment Amount | 129390.79 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 178 |
| Number Of Beneficiaries Age 65 to 74 | 273 |
| Number Of Beneficiaries Age 75 to 84 | 162 |
| Number Of Beneficiaries Age Greater 84 | 58 |
| Number Of Female Beneficiaries | 314 |
| Number Of Male Beneficiaries | 357 |
| Number Of Non Hispanic White Beneficiaries | 456 |
| Number Of Black or African American Beneficiaries | 124 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 74 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 480 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 191 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 51 |
| Percent Of With Chronic Kidney Disease | 54 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 54 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 61 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 3.2664 |