| National Provider Identifier [NPI]: | 1053371054 |
| Last Name Of The Provider | ANDERSON |
| First Name Of The Provider | CLINTON |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2490 W 26TH AVE |
| Street Address 2 Of The Provider | SUITE 220A |
| City Of The Provider | DENVER |
| Zip Code Of The Provider | 802115314 |
| 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 | 193 |
| Number Of Services | 5626 |
| Number Of Medicare Beneficiaries | 2256 |
| Total Submitted Charge Amount | 607861 |
| Total Medicare Allowed Amount | 154674.09 |
| Total Medicare Payment Amount | 116636.27 |
| Total Medicare Standardized Payment Amount | 119155.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 2541 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 2227 |
| Total Drug Medicare AllowedAmount | 1005.51 |
| Total Drug Medicare PaymentAmount | 774.77 |
| Total Drug Medicare Standardized Payment Amount | 774.77 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 190 |
| Number Of Medical Services | 3085 |
| Number Of Medicare Beneficiaries With Medical Services | 2256 |
| Total Medical Submitted Charge Amount | 605634 |
| Total Medical Medicare Allowed Amount | 153668.58 |
| Total Medical Medicare Payment Amount | 115861.5 |
| Total Medical Medicare Standardized Payment Amount | 118380.29 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 478 |
| Number Of Beneficiaries Age 65 to 74 | 915 |
| Number Of Beneficiaries Age 75 to 84 | 562 |
| Number Of Beneficiaries Age Greater 84 | 301 |
| Number Of Female Beneficiaries | 1319 |
| Number Of Male Beneficiaries | 937 |
| Number Of Non Hispanic White Beneficiaries | 1842 |
| Number Of Black or African American Beneficiaries | 32 |
| Number Of AsianPacific Islander Beneficiaries | 42 |
| Number Of Hispanic Beneficiaries | 305 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1720 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 536 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5985 |