| National Provider Identifier [NPI]: | 1558357137 |
| Last Name Of The Provider | FIRESTONE |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | I |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 114 WOODLAND ST |
| Street Address 2 Of The Provider | RADIOLOGY DEPARTMENT |
| City Of The Provider | HARTFORD |
| Zip Code Of The Provider | 061051208 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 168 |
| Number Of Services | 4819 |
| Number Of Medicare Beneficiaries | 2422 |
| Total Submitted Charge Amount | 454387.4 |
| Total Medicare Allowed Amount | 166355 |
| Total Medicare Payment Amount | 125889.78 |
| Total Medicare Standardized Payment Amount | 119620.65 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 1199 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 1437.4 |
| Total Drug Medicare AllowedAmount | 689.36 |
| Total Drug Medicare PaymentAmount | 540.47 |
| Total Drug Medicare Standardized Payment Amount | 540.47 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 165 |
| Number Of Medical Services | 3620 |
| Number Of Medicare Beneficiaries With Medical Services | 2422 |
| Total Medical Submitted Charge Amount | 452950 |
| Total Medical Medicare Allowed Amount | 165665.64 |
| Total Medical Medicare Payment Amount | 125349.31 |
| Total Medical Medicare Standardized Payment Amount | 119080.18 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 371 |
| Number Of Beneficiaries Age 65 to 74 | 697 |
| Number Of Beneficiaries Age 75 to 84 | 819 |
| Number Of Beneficiaries Age Greater 84 | 535 |
| Number Of Female Beneficiaries | 1426 |
| Number Of Male Beneficiaries | 996 |
| Number Of Non Hispanic White Beneficiaries | 1785 |
| Number Of Black or African American Beneficiaries | 377 |
| Number Of AsianPacific Islander Beneficiaries | 38 |
| Number Of Hispanic Beneficiaries | 183 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1495 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 927 |
| Percent Of With Atrial Fibrillation | 26 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 1.9682 |