| National Provider Identifier [NPI]: | 1508848417 |
| Last Name Of The Provider | KOONCE |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8901 CARTI WAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | LITTLE ROCK |
| Zip Code Of The Provider | 722056523 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 101 |
| Number Of Services | 87082 |
| Number Of Medicare Beneficiaries | 1955 |
| Total Submitted Charge Amount | 4296846.64 |
| Total Medicare Allowed Amount | 1415646.75 |
| Total Medicare Payment Amount | 1085124.61 |
| Total Medicare Standardized Payment Amount | 1146060.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 79102 |
| Number Of Medicare Beneficiaries With Drug Services | 643 |
| Total Drug Submitted ChargeAmount | 37852 |
| Total Drug Medicare AllowedAmount | 14694.08 |
| Total Drug Medicare PaymentAmount | 10901.78 |
| Total Drug Medicare Standardized Payment Amount | 10901.78 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 90 |
| Number Of Medical Services | 7980 |
| Number Of Medicare Beneficiaries With Medical Services | 1955 |
| Total Medical Submitted Charge Amount | 4258994.64 |
| Total Medical Medicare Allowed Amount | 1400952.67 |
| Total Medical Medicare Payment Amount | 1074222.83 |
| Total Medical Medicare Standardized Payment Amount | 1135159.19 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 288 |
| Number Of Beneficiaries Age 65 to 74 | 965 |
| Number Of Beneficiaries Age 75 to 84 | 555 |
| Number Of Beneficiaries Age Greater 84 | 147 |
| Number Of Female Beneficiaries | 1148 |
| Number Of Male Beneficiaries | 807 |
| Number Of Non Hispanic White Beneficiaries | 1670 |
| Number Of Black or African American Beneficiaries | 251 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1693 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 262 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 59 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.7859 |