| National Provider Identifier [NPI]: | 1922274034 |
| Last Name Of The Provider | BREAULT |
| First Name Of The Provider | STEVEN |
| 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 | 110 KINGSLEY LN |
| Street Address 2 Of The Provider | SUITE 305 |
| City Of The Provider | NORFOLK |
| Zip Code Of The Provider | 235054614 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 205 |
| Number Of Services | 7514 |
| Number Of Medicare Beneficiaries | 5450 |
| Total Submitted Charge Amount | 859301 |
| Total Medicare Allowed Amount | 237804.97 |
| Total Medicare Payment Amount | 184256.68 |
| Total Medicare Standardized Payment Amount | 190011.88 |
| 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 | 205 |
| Number Of Medical Services | 7514 |
| Number Of Medicare Beneficiaries With Medical Services | 5450 |
| Total Medical Submitted Charge Amount | 859301 |
| Total Medical Medicare Allowed Amount | 237804.97 |
| Total Medical Medicare Payment Amount | 184256.68 |
| Total Medical Medicare Standardized Payment Amount | 190011.88 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 697 |
| Number Of Beneficiaries Age 65 to 74 | 2180 |
| Number Of Beneficiaries Age 75 to 84 | 1698 |
| Number Of Beneficiaries Age Greater 84 | 875 |
| Number Of Female Beneficiaries | 3325 |
| Number Of Male Beneficiaries | 2125 |
| Number Of Non Hispanic White Beneficiaries | 4154 |
| Number Of Black or African American Beneficiaries | 1016 |
| Number Of AsianPacific Islander Beneficiaries | 101 |
| Number Of Hispanic Beneficiaries | 97 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 4651 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 799 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.6542 |