| National Provider Identifier [NPI]: | 1164400644 |
| Last Name Of The Provider | GRISSOM |
| First Name Of The Provider | LARRY |
| 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 | 800 PEAKWOOD DR |
| Street Address 2 Of The Provider | SUITE 5E |
| City Of The Provider | HOUSTON |
| Zip Code Of The Provider | 770902900 |
| 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 | 147 |
| Number Of Services | 3357 |
| Number Of Medicare Beneficiaries | 2191 |
| Total Submitted Charge Amount | 414689 |
| Total Medicare Allowed Amount | 93122.35 |
| Total Medicare Payment Amount | 73046.71 |
| Total Medicare Standardized Payment Amount | 72968.82 |
| 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 | 147 |
| Number Of Medical Services | 3357 |
| Number Of Medicare Beneficiaries With Medical Services | 2191 |
| Total Medical Submitted Charge Amount | 414689 |
| Total Medical Medicare Allowed Amount | 93122.35 |
| Total Medical Medicare Payment Amount | 73046.71 |
| Total Medical Medicare Standardized Payment Amount | 72968.82 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 353 |
| Number Of Beneficiaries Age 65 to 74 | 877 |
| Number Of Beneficiaries Age 75 to 84 | 642 |
| Number Of Beneficiaries Age Greater 84 | 319 |
| Number Of Female Beneficiaries | 1519 |
| Number Of Male Beneficiaries | 672 |
| Number Of Non Hispanic White Beneficiaries | 1616 |
| Number Of Black or African American Beneficiaries | 305 |
| Number Of AsianPacific Islander Beneficiaries | 66 |
| Number Of Hispanic Beneficiaries | 191 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1665 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 526 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 1.9833 |