| National Provider Identifier [NPI]: | 1568451508 |
| Last Name Of The Provider | SAMUELSON |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6449 38TH AVE N |
| Street Address 2 Of The Provider | SUITE C4 |
| City Of The Provider | ST PETERSBURG |
| Zip Code Of The Provider | 337101655 |
| 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 | 226 |
| Number Of Services | 7137 |
| Number Of Medicare Beneficiaries | 3954 |
| Total Submitted Charge Amount | 1550429 |
| Total Medicare Allowed Amount | 242960.51 |
| Total Medicare Payment Amount | 187767.55 |
| Total Medicare Standardized Payment Amount | 185924.51 |
| 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 | 226 |
| Number Of Medical Services | 7137 |
| Number Of Medicare Beneficiaries With Medical Services | 3954 |
| Total Medical Submitted Charge Amount | 1550429 |
| Total Medical Medicare Allowed Amount | 242960.51 |
| Total Medical Medicare Payment Amount | 187767.55 |
| Total Medical Medicare Standardized Payment Amount | 185924.51 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 911 |
| Number Of Beneficiaries Age 65 to 74 | 1040 |
| Number Of Beneficiaries Age 75 to 84 | 1084 |
| Number Of Beneficiaries Age Greater 84 | 919 |
| Number Of Female Beneficiaries | 2313 |
| Number Of Male Beneficiaries | 1641 |
| Number Of Non Hispanic White Beneficiaries | 3053 |
| Number Of Black or African American Beneficiaries | 396 |
| Number Of AsianPacific Islander Beneficiaries | 52 |
| Number Of Hispanic Beneficiaries | 402 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2188 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1766 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 34 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 45 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 63 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 15 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 2.2531 |