| National Provider Identifier [NPI]: | 1093895765 |
| Last Name Of The Provider | BOUCHARD |
| First Name Of The Provider | EDWARD |
| 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 | 6983 E FOWLER AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | TAMPA |
| Zip Code Of The Provider | 336171714 |
| 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 | 217 |
| Number Of Services | 9112 |
| Number Of Medicare Beneficiaries | 6266 |
| Total Submitted Charge Amount | 1977125 |
| Total Medicare Allowed Amount | 270467.84 |
| Total Medicare Payment Amount | 208122.05 |
| Total Medicare Standardized Payment Amount | 209570.64 |
| 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 | 217 |
| Number Of Medical Services | 9112 |
| Number Of Medicare Beneficiaries With Medical Services | 6266 |
| Total Medical Submitted Charge Amount | 1977125 |
| Total Medical Medicare Allowed Amount | 270467.84 |
| Total Medical Medicare Payment Amount | 208122.05 |
| Total Medical Medicare Standardized Payment Amount | 209570.64 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 1012 |
| Number Of Beneficiaries Age 65 to 74 | 1717 |
| Number Of Beneficiaries Age 75 to 84 | 2027 |
| Number Of Beneficiaries Age Greater 84 | 1510 |
| Number Of Female Beneficiaries | 3687 |
| Number Of Male Beneficiaries | 2579 |
| Number Of Non Hispanic White Beneficiaries | 5388 |
| Number Of Black or African American Beneficiaries | 363 |
| Number Of AsianPacific Islander Beneficiaries | 55 |
| Number Of Hispanic Beneficiaries | 411 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 4410 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1856 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 32 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 41 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 66 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 2.1708 |