| National Provider Identifier [NPI]: | 1205801016 |
| Last Name Of The Provider | SHOCKLEY |
| First Name Of The Provider | JOEL |
| 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 | 111 S GRANT AVE |
| Street Address 2 Of The Provider | 3RD FLOOR RADIOLOGY DEPT |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 432154701 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 135 |
| Number Of Services | 5029 |
| Number Of Medicare Beneficiaries | 3253 |
| Total Submitted Charge Amount | 481331 |
| Total Medicare Allowed Amount | 117153.11 |
| Total Medicare Payment Amount | 94918.51 |
| Total Medicare Standardized Payment Amount | 97605.11 |
| 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 | 135 |
| Number Of Medical Services | 5029 |
| Number Of Medicare Beneficiaries With Medical Services | 3253 |
| Total Medical Submitted Charge Amount | 481331 |
| Total Medical Medicare Allowed Amount | 117153.11 |
| Total Medical Medicare Payment Amount | 94918.51 |
| Total Medical Medicare Standardized Payment Amount | 97605.11 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 888 |
| Number Of Beneficiaries Age 65 to 74 | 1278 |
| Number Of Beneficiaries Age 75 to 84 | 756 |
| Number Of Beneficiaries Age Greater 84 | 331 |
| Number Of Female Beneficiaries | 2351 |
| Number Of Male Beneficiaries | 902 |
| Number Of Non Hispanic White Beneficiaries | 2631 |
| Number Of Black or African American Beneficiaries | 535 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 45 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2100 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1153 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.5542 |