| National Provider Identifier [NPI]: | 1730138751 |
| Last Name Of The Provider | LEWIS |
| First Name Of The Provider | BOB |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11209 N TATUM BLVD |
| Street Address 2 Of The Provider | SUITE #110 |
| City Of The Provider | PHOENIX |
| Zip Code Of The Provider | 850283091 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 155 |
| Number Of Services | 6446 |
| Number Of Medicare Beneficiaries | 3753 |
| Total Submitted Charge Amount | 596509.5 |
| Total Medicare Allowed Amount | 131418.27 |
| Total Medicare Payment Amount | 98460.17 |
| Total Medicare Standardized Payment Amount | 100306.47 |
| 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 | 155 |
| Number Of Medical Services | 6446 |
| Number Of Medicare Beneficiaries With Medical Services | 3753 |
| Total Medical Submitted Charge Amount | 596509.5 |
| Total Medical Medicare Allowed Amount | 131418.27 |
| Total Medical Medicare Payment Amount | 98460.17 |
| Total Medical Medicare Standardized Payment Amount | 100306.47 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 616 |
| Number Of Beneficiaries Age 65 to 74 | 1536 |
| Number Of Beneficiaries Age 75 to 84 | 1066 |
| Number Of Beneficiaries Age Greater 84 | 535 |
| Number Of Female Beneficiaries | 2097 |
| Number Of Male Beneficiaries | 1656 |
| Number Of Non Hispanic White Beneficiaries | 2910 |
| Number Of Black or African American Beneficiaries | 197 |
| Number Of AsianPacific Islander Beneficiaries | 74 |
| Number Of Hispanic Beneficiaries | 431 |
| Number Of American Indian Alaska Native Beneficiaries | 96 |
| Number Of Beneficiaries With Race Not Else where Classified | 45 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2853 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 900 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.8603 |