| National Provider Identifier [NPI]: | 1528220274 |
| Last Name Of The Provider | FIELDS |
| First Name Of The Provider | BRAXTON |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1120 15TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | AUGUSTA |
| Zip Code Of The Provider | 309120004 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 155 |
| Number Of Services | 8823 |
| Number Of Medicare Beneficiaries | 940 |
| Total Submitted Charge Amount | 727572.85 |
| Total Medicare Allowed Amount | 174423.43 |
| Total Medicare Payment Amount | 138061.94 |
| Total Medicare Standardized Payment Amount | 151388.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 6998 |
| Number Of Medicare Beneficiaries With Drug Services | 150 |
| Total Drug Submitted ChargeAmount | 26068 |
| Total Drug Medicare AllowedAmount | 3030.72 |
| Total Drug Medicare PaymentAmount | 2317.5 |
| Total Drug Medicare Standardized Payment Amount | 2317.5 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 149 |
| Number Of Medical Services | 1825 |
| Number Of Medicare Beneficiaries With Medical Services | 940 |
| Total Medical Submitted Charge Amount | 701504.85 |
| Total Medical Medicare Allowed Amount | 171392.71 |
| Total Medical Medicare Payment Amount | 135744.44 |
| Total Medical Medicare Standardized Payment Amount | 149070.52 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 128 |
| Number Of Beneficiaries Age 65 to 74 | 459 |
| Number Of Beneficiaries Age 75 to 84 | 273 |
| Number Of Beneficiaries Age Greater 84 | 80 |
| Number Of Female Beneficiaries | 594 |
| Number Of Male Beneficiaries | 346 |
| Number Of Non Hispanic White Beneficiaries | 715 |
| Number Of Black or African American Beneficiaries | 191 |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 831 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 109 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0718 |