| National Provider Identifier [NPI]: | 1215115233 |
| Last Name Of The Provider | COSTELLO |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D., PH.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1364 CLIFTON RD NE |
| Street Address 2 Of The Provider | EMORY UNIVERSITY RADIOLOGY RM D-125A |
| City Of The Provider | ATLANTA |
| Zip Code Of The Provider | 303221064 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 64 |
| Number Of Services | 2012 |
| Number Of Medicare Beneficiaries | 1372 |
| Total Submitted Charge Amount | 414421 |
| Total Medicare Allowed Amount | 113076.62 |
| Total Medicare Payment Amount | 85995.35 |
| Total Medicare Standardized Payment Amount | 88866.71 |
| 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 | 64 |
| Number Of Medical Services | 2012 |
| Number Of Medicare Beneficiaries With Medical Services | 1372 |
| Total Medical Submitted Charge Amount | 414421 |
| Total Medical Medicare Allowed Amount | 113076.62 |
| Total Medical Medicare Payment Amount | 85995.35 |
| Total Medical Medicare Standardized Payment Amount | 88866.71 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 301 |
| Number Of Beneficiaries Age 65 to 74 | 554 |
| Number Of Beneficiaries Age 75 to 84 | 356 |
| Number Of Beneficiaries Age Greater 84 | 161 |
| Number Of Female Beneficiaries | 727 |
| Number Of Male Beneficiaries | 645 |
| Number Of Non Hispanic White Beneficiaries | 996 |
| Number Of Black or African American Beneficiaries | 45 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 227 |
| Number Of American Indian Alaska Native Beneficiaries | 76 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 999 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 373 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 2.1155 |