| National Provider Identifier [NPI]: | 1841450376 |
| Last Name Of The Provider | COLBY |
| First Name Of The Provider | ETHAN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3901 W 15TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PLANO |
| Zip Code Of The Provider | 750757738 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 163 |
| Number Of Services | 2986 |
| Number Of Medicare Beneficiaries | 2281 |
| Total Submitted Charge Amount | 438619.89 |
| Total Medicare Allowed Amount | 93807.11 |
| Total Medicare Payment Amount | 71318.89 |
| Total Medicare Standardized Payment Amount | 74481.68 |
| 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 | 163 |
| Number Of Medical Services | 2986 |
| Number Of Medicare Beneficiaries With Medical Services | 2281 |
| Total Medical Submitted Charge Amount | 438619.89 |
| Total Medical Medicare Allowed Amount | 93807.11 |
| Total Medical Medicare Payment Amount | 71318.89 |
| Total Medical Medicare Standardized Payment Amount | 74481.68 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 337 |
| Number Of Beneficiaries Age 65 to 74 | 886 |
| Number Of Beneficiaries Age 75 to 84 | 647 |
| Number Of Beneficiaries Age Greater 84 | 411 |
| Number Of Female Beneficiaries | 1335 |
| Number Of Male Beneficiaries | 946 |
| Number Of Non Hispanic White Beneficiaries | 1938 |
| Number Of Black or African American Beneficiaries | 159 |
| Number Of AsianPacific Islander Beneficiaries | 51 |
| Number Of Hispanic Beneficiaries | 97 |
| Number Of American Indian Alaska Native Beneficiaries | 14 |
| Number Of Beneficiaries With Race Not Else where Classified | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1819 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 462 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 1.9115 |