| National Provider Identifier [NPI]: | 1003891060 |
| Last Name Of The Provider | MCCOLLUM |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1008 MINNEQUA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | PUEBLO |
| Zip Code Of The Provider | 810043733 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 208 |
| Number Of Services | 5763 |
| Number Of Medicare Beneficiaries | 3506 |
| Total Submitted Charge Amount | 582831.25 |
| Total Medicare Allowed Amount | 169616.27 |
| Total Medicare Payment Amount | 128912.44 |
| Total Medicare Standardized Payment Amount | 130043.28 |
| 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 | 208 |
| Number Of Medical Services | 5763 |
| Number Of Medicare Beneficiaries With Medical Services | 3506 |
| Total Medical Submitted Charge Amount | 582831.25 |
| Total Medical Medicare Allowed Amount | 169616.27 |
| Total Medical Medicare Payment Amount | 128912.44 |
| Total Medical Medicare Standardized Payment Amount | 130043.28 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 705 |
| Number Of Beneficiaries Age 65 to 74 | 1394 |
| Number Of Beneficiaries Age 75 to 84 | 930 |
| Number Of Beneficiaries Age Greater 84 | 477 |
| Number Of Female Beneficiaries | 2231 |
| Number Of Male Beneficiaries | 1275 |
| Number Of Non Hispanic White Beneficiaries | 2716 |
| Number Of Black or African American Beneficiaries | 42 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 701 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 27 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2522 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 984 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3871 |