| National Provider Identifier [NPI]: | 1548247729 |
| Last Name Of The Provider | BLACK |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11 UPPER RIVERDALE RD SW |
| Street Address 2 Of The Provider | |
| City Of The Provider | RIVERDALE |
| Zip Code Of The Provider | 302742615 |
| 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 | 164 |
| Number Of Services | 2861 |
| Number Of Medicare Beneficiaries | 1804 |
| Total Submitted Charge Amount | 389240 |
| Total Medicare Allowed Amount | 95200.66 |
| Total Medicare Payment Amount | 74669.69 |
| Total Medicare Standardized Payment Amount | 75624.7 |
| 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 | 164 |
| Number Of Medical Services | 2861 |
| Number Of Medicare Beneficiaries With Medical Services | 1804 |
| Total Medical Submitted Charge Amount | 389240 |
| Total Medical Medicare Allowed Amount | 95200.66 |
| Total Medical Medicare Payment Amount | 74669.69 |
| Total Medical Medicare Standardized Payment Amount | 75624.7 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 438 |
| Number Of Beneficiaries Age 65 to 74 | 662 |
| Number Of Beneficiaries Age 75 to 84 | 459 |
| Number Of Beneficiaries Age Greater 84 | 245 |
| Number Of Female Beneficiaries | 1157 |
| Number Of Male Beneficiaries | 647 |
| Number Of Non Hispanic White Beneficiaries | 1161 |
| Number Of Black or African American Beneficiaries | 567 |
| Number Of AsianPacific Islander Beneficiaries | 33 |
| Number Of Hispanic Beneficiaries | 31 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1314 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 490 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.8915 |