| National Provider Identifier [NPI]: | 1083697478 |
| Last Name Of The Provider | BROADWATER |
| First Name Of The Provider | STEPHEN |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3614 J DEWEY GRAY CIRCLE |
| Street Address 2 Of The Provider | ST A |
| City Of The Provider | AUGUSTA |
| Zip Code Of The Provider | 30909 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 2374 |
| Number Of Medicare Beneficiaries | 670 |
| Total Submitted Charge Amount | 810333 |
| Total Medicare Allowed Amount | 296180.33 |
| Total Medicare Payment Amount | 218362.57 |
| Total Medicare Standardized Payment Amount | 229024.57 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 160 |
| Number Of Medicare Beneficiaries With Drug Services | 40 |
| Total Drug Submitted ChargeAmount | 17280 |
| Total Drug Medicare AllowedAmount | 8468.44 |
| Total Drug Medicare PaymentAmount | 6639.19 |
| Total Drug Medicare Standardized Payment Amount | 6639.19 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 2214 |
| Number Of Medicare Beneficiaries With Medical Services | 670 |
| Total Medical Submitted Charge Amount | 793053 |
| Total Medical Medicare Allowed Amount | 287711.89 |
| Total Medical Medicare Payment Amount | 211723.38 |
| Total Medical Medicare Standardized Payment Amount | 222385.38 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 69 |
| Number Of Beneficiaries Age 65 to 74 | 305 |
| Number Of Beneficiaries Age 75 to 84 | 229 |
| Number Of Beneficiaries Age Greater 84 | 67 |
| Number Of Female Beneficiaries | 347 |
| Number Of Male Beneficiaries | 323 |
| Number Of Non Hispanic White Beneficiaries | 563 |
| Number Of Black or African American Beneficiaries | 96 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 568 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 102 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 66 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2764 |