| National Provider Identifier [NPI]: | 1598732299 |
| Last Name Of The Provider | CROCKER |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 620 SKYLINE DRIVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | JACKSON |
| Zip Code Of The Provider | 383013901 |
| State Code Of The Provider | TN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 340 |
| Number Of Services | 15401 |
| Number Of Medicare Beneficiaries | 3356 |
| Total Submitted Charge Amount | 2917737 |
| Total Medicare Allowed Amount | 787278.14 |
| Total Medicare Payment Amount | 604804.25 |
| Total Medicare Standardized Payment Amount | 662688.35 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 9028 |
| Number Of Medicare Beneficiaries With Drug Services | 129 |
| Total Drug Submitted ChargeAmount | 30909 |
| Total Drug Medicare AllowedAmount | 6290.6 |
| Total Drug Medicare PaymentAmount | 4913.67 |
| Total Drug Medicare Standardized Payment Amount | 4913.67 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 338 |
| Number Of Medical Services | 6373 |
| Number Of Medicare Beneficiaries With Medical Services | 3356 |
| Total Medical Submitted Charge Amount | 2886828 |
| Total Medical Medicare Allowed Amount | 780987.54 |
| Total Medical Medicare Payment Amount | 599890.58 |
| Total Medical Medicare Standardized Payment Amount | 657774.68 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 764 |
| Number Of Beneficiaries Age 65 to 74 | 1227 |
| Number Of Beneficiaries Age 75 to 84 | 946 |
| Number Of Beneficiaries Age Greater 84 | 419 |
| Number Of Female Beneficiaries | 1847 |
| Number Of Male Beneficiaries | 1509 |
| Number Of Non Hispanic White Beneficiaries | 2644 |
| Number Of Black or African American Beneficiaries | 665 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2108 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1248 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 65 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 16 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.3958 |