| National Provider Identifier [NPI]: | 1932199742 |
| Last Name Of The Provider | KEENAN |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 770 PINE ST STE 290 |
| Street Address 2 Of The Provider | ATTN: RADIOLOGY DEPARTMENT |
| City Of The Provider | MACON |
| Zip Code Of The Provider | 312017516 |
| 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 | 247 |
| Number Of Services | 9643 |
| Number Of Medicare Beneficiaries | 4144 |
| Total Submitted Charge Amount | 1176859 |
| Total Medicare Allowed Amount | 264039.54 |
| Total Medicare Payment Amount | 200648.29 |
| Total Medicare Standardized Payment Amount | 211976.47 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 3253 |
| Number Of Medicare Beneficiaries With Drug Services | 62 |
| Total Drug Submitted ChargeAmount | 13757 |
| Total Drug Medicare AllowedAmount | 629.56 |
| Total Drug Medicare PaymentAmount | 493.52 |
| Total Drug Medicare Standardized Payment Amount | 493.52 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 244 |
| Number Of Medical Services | 6390 |
| Number Of Medicare Beneficiaries With Medical Services | 4143 |
| Total Medical Submitted Charge Amount | 1163102 |
| Total Medical Medicare Allowed Amount | 263409.98 |
| Total Medical Medicare Payment Amount | 200154.77 |
| Total Medical Medicare Standardized Payment Amount | 211482.95 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 990 |
| Number Of Beneficiaries Age 65 to 74 | 1427 |
| Number Of Beneficiaries Age 75 to 84 | 1152 |
| Number Of Beneficiaries Age Greater 84 | 575 |
| Number Of Female Beneficiaries | 2319 |
| Number Of Male Beneficiaries | 1825 |
| Number Of Non Hispanic White Beneficiaries | 2799 |
| Number Of Black or African American Beneficiaries | 1281 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 26 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2870 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1274 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.0582 |