| National Provider Identifier [NPI]: | 1972750446 |
| Last Name Of The Provider | MACIP |
| First Name Of The Provider | STACEY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4801 AMBASSADOR CAFFERY PKWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAFAYETTE |
| Zip Code Of The Provider | 705086917 |
| 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 | 174 |
| Number Of Services | 4531 |
| Number Of Medicare Beneficiaries | 2816 |
| Total Submitted Charge Amount | 476613 |
| Total Medicare Allowed Amount | 119163.56 |
| Total Medicare Payment Amount | 88611.86 |
| Total Medicare Standardized Payment Amount | 92436.77 |
| 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 | 174 |
| Number Of Medical Services | 4531 |
| Number Of Medicare Beneficiaries With Medical Services | 2816 |
| Total Medical Submitted Charge Amount | 476613 |
| Total Medical Medicare Allowed Amount | 119163.56 |
| Total Medical Medicare Payment Amount | 88611.86 |
| Total Medical Medicare Standardized Payment Amount | 92436.77 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 717 |
| Number Of Beneficiaries Age 65 to 74 | 963 |
| Number Of Beneficiaries Age 75 to 84 | 766 |
| Number Of Beneficiaries Age Greater 84 | 370 |
| Number Of Female Beneficiaries | 1690 |
| Number Of Male Beneficiaries | 1126 |
| Number Of Non Hispanic White Beneficiaries | 1949 |
| Number Of Black or African American Beneficiaries | 753 |
| Number Of AsianPacific Islander Beneficiaries | 17 |
| Number Of Hispanic Beneficiaries | 76 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1619 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1197 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 7 |
| 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 | 1.7346 |