| National Provider Identifier [NPI]: | 1972565000 |
| Last Name Of The Provider | NAM |
| First Name Of The Provider | JERRY |
| Middle Initial Of The Provider | I |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2722 OSLER BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BRYAN |
| Zip Code Of The Provider | 778022517 |
| 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 | 219 |
| Number Of Services | 7691 |
| Number Of Medicare Beneficiaries | 3516 |
| Total Submitted Charge Amount | 924443 |
| Total Medicare Allowed Amount | 198635.44 |
| Total Medicare Payment Amount | 146591.6 |
| Total Medicare Standardized Payment Amount | 155434.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 2166 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 2780 |
| Total Drug Medicare AllowedAmount | 836.22 |
| Total Drug Medicare PaymentAmount | 655.65 |
| Total Drug Medicare Standardized Payment Amount | 655.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 217 |
| Number Of Medical Services | 5525 |
| Number Of Medicare Beneficiaries With Medical Services | 3516 |
| Total Medical Submitted Charge Amount | 921663 |
| Total Medical Medicare Allowed Amount | 197799.22 |
| Total Medical Medicare Payment Amount | 145935.95 |
| Total Medical Medicare Standardized Payment Amount | 154778.54 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 543 |
| Number Of Beneficiaries Age 65 to 74 | 1309 |
| Number Of Beneficiaries Age 75 to 84 | 1111 |
| Number Of Beneficiaries Age Greater 84 | 553 |
| Number Of Female Beneficiaries | 2147 |
| Number Of Male Beneficiaries | 1369 |
| Number Of Non Hispanic White Beneficiaries | 2736 |
| Number Of Black or African American Beneficiaries | 525 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 228 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2672 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 844 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.611 |