| National Provider Identifier [NPI]: | 1538100060 |
| Last Name Of The Provider | THEBERT |
| First Name Of The Provider | ANDRE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4000 KRESGE WAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | LOUISVILLE |
| Zip Code Of The Provider | 402074605 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 178 |
| Number Of Services | 8140 |
| Number Of Medicare Beneficiaries | 5166 |
| Total Submitted Charge Amount | 1253725.5 |
| Total Medicare Allowed Amount | 222691.61 |
| Total Medicare Payment Amount | 176299.1 |
| Total Medicare Standardized Payment Amount | 187476.94 |
| 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 | 178 |
| Number Of Medical Services | 8140 |
| Number Of Medicare Beneficiaries With Medical Services | 5166 |
| Total Medical Submitted Charge Amount | 1253725.5 |
| Total Medical Medicare Allowed Amount | 222691.61 |
| Total Medical Medicare Payment Amount | 176299.1 |
| Total Medical Medicare Standardized Payment Amount | 187476.94 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 541 |
| Number Of Beneficiaries Age 65 to 74 | 1835 |
| Number Of Beneficiaries Age 75 to 84 | 1775 |
| Number Of Beneficiaries Age Greater 84 | 1015 |
| Number Of Female Beneficiaries | 3333 |
| Number Of Male Beneficiaries | 1833 |
| Number Of Non Hispanic White Beneficiaries | 4777 |
| Number Of Black or African American Beneficiaries | 276 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 34 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 55 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4529 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 637 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.603 |