| National Provider Identifier [NPI]: | 1881640688 |
| Last Name Of The Provider | NOLT |
| First Name Of The Provider | BRYAN |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1619 N GREENWOOD ST |
| Street Address 2 Of The Provider | SUITE 103 |
| City Of The Provider | PUEBLO |
| Zip Code Of The Provider | 810032644 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 210 |
| Number Of Services | 4796 |
| Number Of Medicare Beneficiaries | 2755 |
| Total Submitted Charge Amount | 1121797 |
| Total Medicare Allowed Amount | 232213.35 |
| Total Medicare Payment Amount | 180051.81 |
| Total Medicare Standardized Payment Amount | 180503.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 315 |
| Number Of Medicare Beneficiaries With Drug Services | 30 |
| Total Drug Submitted ChargeAmount | 3455 |
| Total Drug Medicare AllowedAmount | 189.25 |
| Total Drug Medicare PaymentAmount | 148.33 |
| Total Drug Medicare Standardized Payment Amount | 148.33 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 207 |
| Number Of Medical Services | 4481 |
| Number Of Medicare Beneficiaries With Medical Services | 2755 |
| Total Medical Submitted Charge Amount | 1118342 |
| Total Medical Medicare Allowed Amount | 232024.1 |
| Total Medical Medicare Payment Amount | 179903.48 |
| Total Medical Medicare Standardized Payment Amount | 180355.53 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 611 |
| Number Of Beneficiaries Age 65 to 74 | 968 |
| Number Of Beneficiaries Age 75 to 84 | 770 |
| Number Of Beneficiaries Age Greater 84 | 406 |
| Number Of Female Beneficiaries | 1587 |
| Number Of Male Beneficiaries | 1168 |
| Number Of Non Hispanic White Beneficiaries | 1960 |
| Number Of Black or African American Beneficiaries | 34 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 722 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1929 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 826 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.5969 |