| National Provider Identifier [NPI]: | 1295701316 |
| Last Name Of The Provider | CHOCALLO |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3950 AUSTELL RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | AUSTELL |
| Zip Code Of The Provider | 301061121 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 150 |
| Number Of Services | 5974 |
| Number Of Medicare Beneficiaries | 3791 |
| Total Submitted Charge Amount | 763606 |
| Total Medicare Allowed Amount | 163336.23 |
| Total Medicare Payment Amount | 132708.44 |
| Total Medicare Standardized Payment Amount | 133526.64 |
| 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 | 150 |
| Number Of Medical Services | 5974 |
| Number Of Medicare Beneficiaries With Medical Services | 3791 |
| Total Medical Submitted Charge Amount | 763606 |
| Total Medical Medicare Allowed Amount | 163336.23 |
| Total Medical Medicare Payment Amount | 132708.44 |
| Total Medical Medicare Standardized Payment Amount | 133526.64 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 646 |
| Number Of Beneficiaries Age 65 to 74 | 1587 |
| Number Of Beneficiaries Age 75 to 84 | 1088 |
| Number Of Beneficiaries Age Greater 84 | 470 |
| Number Of Female Beneficiaries | 2651 |
| Number Of Male Beneficiaries | 1140 |
| Number Of Non Hispanic White Beneficiaries | 3001 |
| Number Of Black or African American Beneficiaries | 623 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 94 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 36 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2988 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 803 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.7877 |