| National Provider Identifier [NPI]: | 1912950635 |
| Last Name Of The Provider | BULLEY |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2020 59TH ST WEST |
| Street Address 2 Of The Provider | BLAKE MEDICAL CENTER |
| City Of The Provider | BRADENTON |
| Zip Code Of The Provider | 34209 |
| 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 | 164 |
| Number Of Services | 7766 |
| Number Of Medicare Beneficiaries | 4444 |
| Total Submitted Charge Amount | 685273 |
| Total Medicare Allowed Amount | 230256.12 |
| Total Medicare Payment Amount | 178358.82 |
| Total Medicare Standardized Payment Amount | 178567.19 |
| 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 | 164 |
| Number Of Medical Services | 7766 |
| Number Of Medicare Beneficiaries With Medical Services | 4444 |
| Total Medical Submitted Charge Amount | 685273 |
| Total Medical Medicare Allowed Amount | 230256.12 |
| Total Medical Medicare Payment Amount | 178358.82 |
| Total Medical Medicare Standardized Payment Amount | 178567.19 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 395 |
| Number Of Beneficiaries Age 65 to 74 | 1597 |
| Number Of Beneficiaries Age 75 to 84 | 1554 |
| Number Of Beneficiaries Age Greater 84 | 898 |
| Number Of Female Beneficiaries | 2652 |
| Number Of Male Beneficiaries | 1792 |
| Number Of Non Hispanic White Beneficiaries | 4127 |
| Number Of Black or African American Beneficiaries | 117 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 158 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 3917 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 527 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3529 |