| National Provider Identifier [NPI]: | 1013976075 |
| Last Name Of The Provider | HALISTA |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 110 KINGSLEY LN |
| Street Address 2 Of The Provider | SUITE 305 |
| City Of The Provider | NORFOLK |
| Zip Code Of The Provider | 235054614 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 205 |
| Number Of Services | 7276 |
| Number Of Medicare Beneficiaries | 4932 |
| Total Submitted Charge Amount | 694476 |
| Total Medicare Allowed Amount | 193510.65 |
| Total Medicare Payment Amount | 153617.88 |
| Total Medicare Standardized Payment Amount | 157903.13 |
| 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 | 205 |
| Number Of Medical Services | 7276 |
| Number Of Medicare Beneficiaries With Medical Services | 4932 |
| Total Medical Submitted Charge Amount | 694476 |
| Total Medical Medicare Allowed Amount | 193510.65 |
| Total Medical Medicare Payment Amount | 153617.88 |
| Total Medical Medicare Standardized Payment Amount | 157903.13 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 588 |
| Number Of Beneficiaries Age 65 to 74 | 2098 |
| Number Of Beneficiaries Age 75 to 84 | 1555 |
| Number Of Beneficiaries Age Greater 84 | 691 |
| Number Of Female Beneficiaries | 3303 |
| Number Of Male Beneficiaries | 1629 |
| Number Of Non Hispanic White Beneficiaries | 3761 |
| Number Of Black or African American Beneficiaries | 872 |
| Number Of AsianPacific Islander Beneficiaries | 107 |
| Number Of Hispanic Beneficiaries | 118 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 4277 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 655 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.449 |