| National Provider Identifier [NPI]: | 1740296706 |
| Last Name Of The Provider | EGAN |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1200 SEVENTH AVE N |
| Street Address 2 Of The Provider | |
| City Of The Provider | ST PETERSBURG |
| Zip Code Of The Provider | 337051300 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 150 |
| Number Of Services | 19619 |
| Number Of Medicare Beneficiaries | 5175 |
| Total Submitted Charge Amount | 1115291.4 |
| Total Medicare Allowed Amount | 370975.56 |
| Total Medicare Payment Amount | 289813.38 |
| Total Medicare Standardized Payment Amount | 296699.32 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 9356 |
| Number Of Medicare Beneficiaries With Drug Services | 94 |
| Total Drug Submitted ChargeAmount | 27209.4 |
| Total Drug Medicare AllowedAmount | 1854.99 |
| Total Drug Medicare PaymentAmount | 1454.22 |
| Total Drug Medicare Standardized Payment Amount | 1454.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 148 |
| Number Of Medical Services | 10263 |
| Number Of Medicare Beneficiaries With Medical Services | 5175 |
| Total Medical Submitted Charge Amount | 1088082 |
| Total Medical Medicare Allowed Amount | 369120.57 |
| Total Medical Medicare Payment Amount | 288359.16 |
| Total Medical Medicare Standardized Payment Amount | 295245.1 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 952 |
| Number Of Beneficiaries Age 65 to 74 | 1772 |
| Number Of Beneficiaries Age 75 to 84 | 1475 |
| Number Of Beneficiaries Age Greater 84 | 976 |
| Number Of Female Beneficiaries | 3252 |
| Number Of Male Beneficiaries | 1923 |
| Number Of Non Hispanic White Beneficiaries | 4190 |
| Number Of Black or African American Beneficiaries | 720 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 154 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 55 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3784 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1391 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.8277 |