| National Provider Identifier [NPI]: | 1215029632 |
| Last Name Of The Provider | DONNELLY |
| First Name Of The Provider | EDWIN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD, PHD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3601 TVC |
| Street Address 2 Of The Provider | |
| City Of The Provider | NASHVILLE |
| Zip Code Of The Provider | 372320001 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 4055 |
| Number Of Medicare Beneficiaries | 2541 |
| Total Submitted Charge Amount | 222924 |
| Total Medicare Allowed Amount | 49356.2 |
| Total Medicare Payment Amount | 35969.37 |
| Total Medicare Standardized Payment Amount | 38224.41 |
| 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 | 43 |
| Number Of Medical Services | 4055 |
| Number Of Medicare Beneficiaries With Medical Services | 2541 |
| Total Medical Submitted Charge Amount | 222924 |
| Total Medical Medicare Allowed Amount | 49356.2 |
| Total Medical Medicare Payment Amount | 35969.37 |
| Total Medical Medicare Standardized Payment Amount | 38224.41 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 643 |
| Number Of Beneficiaries Age 65 to 74 | 1082 |
| Number Of Beneficiaries Age 75 to 84 | 593 |
| Number Of Beneficiaries Age Greater 84 | 223 |
| Number Of Female Beneficiaries | 1163 |
| Number Of Male Beneficiaries | 1378 |
| Number Of Non Hispanic White Beneficiaries | 2212 |
| Number Of Black or African American Beneficiaries | 256 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 34 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2028 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 513 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 2.0379 |