| National Provider Identifier [NPI]: | 1073549879 |
| Last Name Of The Provider | BOUSHKA |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6065 MONTANA AVE |
| Street Address 2 Of The Provider | BLDG A STE 6 |
| City Of The Provider | EL PASO |
| Zip Code Of The Provider | 799251835 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 153 |
| Number Of Services | 48734 |
| Number Of Medicare Beneficiaries | 2655 |
| Total Submitted Charge Amount | 4286854 |
| Total Medicare Allowed Amount | 831417.23 |
| Total Medicare Payment Amount | 642154.22 |
| Total Medicare Standardized Payment Amount | 713926.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 43268 |
| Number Of Medicare Beneficiaries With Drug Services | 646 |
| Total Drug Submitted ChargeAmount | 78602 |
| Total Drug Medicare AllowedAmount | 18657.07 |
| Total Drug Medicare PaymentAmount | 14566.94 |
| Total Drug Medicare Standardized Payment Amount | 14566.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 151 |
| Number Of Medical Services | 5466 |
| Number Of Medicare Beneficiaries With Medical Services | 2655 |
| Total Medical Submitted Charge Amount | 4208252 |
| Total Medical Medicare Allowed Amount | 812760.16 |
| Total Medical Medicare Payment Amount | 627587.28 |
| Total Medical Medicare Standardized Payment Amount | 699359.92 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 458 |
| Number Of Beneficiaries Age 65 to 74 | 1080 |
| Number Of Beneficiaries Age 75 to 84 | 807 |
| Number Of Beneficiaries Age Greater 84 | 310 |
| Number Of Female Beneficiaries | 1788 |
| Number Of Male Beneficiaries | 867 |
| Number Of Non Hispanic White Beneficiaries | 767 |
| Number Of Black or African American Beneficiaries | 105 |
| Number Of AsianPacific Islander Beneficiaries | 33 |
| Number Of Hispanic Beneficiaries | 1724 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1680 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 975 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2494 |