| National Provider Identifier [NPI]: | 1487660171 |
| Last Name Of The Provider | HAZELTON |
| First Name Of The Provider | TODD |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 12901 BRUCE B DOWNS BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | TAMPA |
| Zip Code Of The Provider | 336124742 |
| 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 | 65 |
| Number Of Services | 5127 |
| Number Of Medicare Beneficiaries | 2538 |
| Total Submitted Charge Amount | 456711.5 |
| Total Medicare Allowed Amount | 150238.45 |
| Total Medicare Payment Amount | 113479.54 |
| Total Medicare Standardized Payment Amount | 115126.74 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 830 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 290.5 |
| Total Drug Medicare AllowedAmount | 151.58 |
| Total Drug Medicare PaymentAmount | 118.85 |
| Total Drug Medicare Standardized Payment Amount | 118.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 64 |
| Number Of Medical Services | 4297 |
| Number Of Medicare Beneficiaries With Medical Services | 2533 |
| Total Medical Submitted Charge Amount | 456421 |
| Total Medical Medicare Allowed Amount | 150086.87 |
| Total Medical Medicare Payment Amount | 113360.69 |
| Total Medical Medicare Standardized Payment Amount | 115007.89 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 831 |
| Number Of Beneficiaries Age 65 to 74 | 937 |
| Number Of Beneficiaries Age 75 to 84 | 550 |
| Number Of Beneficiaries Age Greater 84 | 220 |
| Number Of Female Beneficiaries | 1186 |
| Number Of Male Beneficiaries | 1352 |
| Number Of Non Hispanic White Beneficiaries | 1742 |
| Number Of Black or African American Beneficiaries | 447 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 274 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 40 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1661 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 877 |
| Percent Of With Atrial Fibrillation | 25 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 46 |
| Percent Of With Chronic Kidney Disease | 60 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 40 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 68 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 3.0415 |