| National Provider Identifier [NPI]: | 1578587069 |
| Last Name Of The Provider | LACY |
| First Name Of The Provider | JOE |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 815 PENNSYLVANIA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT WORTH |
| Zip Code Of The Provider | 761042224 |
| 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 | 157 |
| Number Of Services | 3101 |
| Number Of Medicare Beneficiaries | 1785 |
| Total Submitted Charge Amount | 339506.74 |
| Total Medicare Allowed Amount | 79269.61 |
| Total Medicare Payment Amount | 57604.6 |
| Total Medicare Standardized Payment Amount | 59528.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 840 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 940 |
| Total Drug Medicare AllowedAmount | 235.22 |
| Total Drug Medicare PaymentAmount | 184.39 |
| Total Drug Medicare Standardized Payment Amount | 184.39 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 155 |
| Number Of Medical Services | 2261 |
| Number Of Medicare Beneficiaries With Medical Services | 1785 |
| Total Medical Submitted Charge Amount | 338566.74 |
| Total Medical Medicare Allowed Amount | 79034.39 |
| Total Medical Medicare Payment Amount | 57420.21 |
| Total Medical Medicare Standardized Payment Amount | 59344.39 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 318 |
| Number Of Beneficiaries Age 65 to 74 | 645 |
| Number Of Beneficiaries Age 75 to 84 | 561 |
| Number Of Beneficiaries Age Greater 84 | 261 |
| Number Of Female Beneficiaries | 1010 |
| Number Of Male Beneficiaries | 775 |
| Number Of Non Hispanic White Beneficiaries | 1375 |
| Number Of Black or African American Beneficiaries | 220 |
| Number Of AsianPacific Islander Beneficiaries | 22 |
| Number Of Hispanic Beneficiaries | 145 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1328 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 457 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 2.1318 |