| National Provider Identifier [NPI]: | 1578550794 |
| Last Name Of The Provider | STEPHAN |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2311 KALISTE SALOOM RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAFAYETTE |
| Zip Code Of The Provider | 705086807 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 210 |
| Number Of Services | 5153 |
| Number Of Medicare Beneficiaries | 3218 |
| Total Submitted Charge Amount | 568054 |
| Total Medicare Allowed Amount | 137842.85 |
| Total Medicare Payment Amount | 101754.03 |
| Total Medicare Standardized Payment Amount | 106905.58 |
| 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 | 210 |
| Number Of Medical Services | 5153 |
| Number Of Medicare Beneficiaries With Medical Services | 3218 |
| Total Medical Submitted Charge Amount | 568054 |
| Total Medical Medicare Allowed Amount | 137842.85 |
| Total Medical Medicare Payment Amount | 101754.03 |
| Total Medical Medicare Standardized Payment Amount | 106905.58 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 772 |
| Number Of Beneficiaries Age 65 to 74 | 1075 |
| Number Of Beneficiaries Age 75 to 84 | 909 |
| Number Of Beneficiaries Age Greater 84 | 462 |
| Number Of Female Beneficiaries | 1849 |
| Number Of Male Beneficiaries | 1369 |
| Number Of Non Hispanic White Beneficiaries | 2332 |
| Number Of Black or African American Beneficiaries | 769 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 78 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1949 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1269 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 63 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.8233 |