| National Provider Identifier [NPI]: | 1629029806 |
| Last Name Of The Provider | WADDELL |
| First Name Of The Provider | GARY |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2900 S LOOP 256 |
| Street Address 2 Of The Provider | |
| City Of The Provider | PALESTINE |
| Zip Code Of The Provider | 758016958 |
| 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 | 203 |
| Number Of Services | 9005 |
| Number Of Medicare Beneficiaries | 3745 |
| Total Submitted Charge Amount | 912437 |
| Total Medicare Allowed Amount | 224977.52 |
| Total Medicare Payment Amount | 171579.34 |
| Total Medicare Standardized Payment Amount | 177951.56 |
| 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 | 203 |
| Number Of Medical Services | 9005 |
| Number Of Medicare Beneficiaries With Medical Services | 3745 |
| Total Medical Submitted Charge Amount | 912437 |
| Total Medical Medicare Allowed Amount | 224977.52 |
| Total Medical Medicare Payment Amount | 171579.34 |
| Total Medical Medicare Standardized Payment Amount | 177951.56 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 747 |
| Number Of Beneficiaries Age 65 to 74 | 1342 |
| Number Of Beneficiaries Age 75 to 84 | 1048 |
| Number Of Beneficiaries Age Greater 84 | 608 |
| Number Of Female Beneficiaries | 2360 |
| Number Of Male Beneficiaries | 1385 |
| Number Of Non Hispanic White Beneficiaries | 2909 |
| Number Of Black or African American Beneficiaries | 549 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 259 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2529 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1216 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5833 |