| National Provider Identifier [NPI]: | 1548482151 |
| Last Name Of The Provider | PRINCE |
| First Name Of The Provider | ANDRE |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 100 SOUTH ASHLEY DRIVE |
| Street Address 2 Of The Provider | SUITE 1500 |
| City Of The Provider | TAMPA |
| Zip Code Of The Provider | 336025318 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 142 |
| Number Of Services | 6678 |
| Number Of Medicare Beneficiaries | 4887 |
| Total Submitted Charge Amount | 1198472 |
| Total Medicare Allowed Amount | 160499.93 |
| Total Medicare Payment Amount | 124001.49 |
| Total Medicare Standardized Payment Amount | 124245.94 |
| 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 | 142 |
| Number Of Medical Services | 6678 |
| Number Of Medicare Beneficiaries With Medical Services | 4887 |
| Total Medical Submitted Charge Amount | 1198472 |
| Total Medical Medicare Allowed Amount | 160499.93 |
| Total Medical Medicare Payment Amount | 124001.49 |
| Total Medical Medicare Standardized Payment Amount | 124245.94 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 1087 |
| Number Of Beneficiaries Age 65 to 74 | 1291 |
| Number Of Beneficiaries Age 75 to 84 | 1466 |
| Number Of Beneficiaries Age Greater 84 | 1043 |
| Number Of Female Beneficiaries | 2849 |
| Number Of Male Beneficiaries | 2038 |
| Number Of Non Hispanic White Beneficiaries | 3988 |
| Number Of Black or African American Beneficiaries | 473 |
| Number Of AsianPacific Islander Beneficiaries | 50 |
| Number Of Hispanic Beneficiaries | 333 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 3214 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1673 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 30 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 40 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 64 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 2.1625 |