| National Provider Identifier [NPI]: | 1497735724 |
| Last Name Of The Provider | WADDELL |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1125 MADISON ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | JEFFERSON CITY |
| Zip Code Of The Provider | 651015227 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 189 |
| Number Of Services | 10499 |
| Number Of Medicare Beneficiaries | 3260 |
| Total Submitted Charge Amount | 946873.23 |
| Total Medicare Allowed Amount | 294579.75 |
| Total Medicare Payment Amount | 218849.91 |
| Total Medicare Standardized Payment Amount | 233317.04 |
| 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 | 189 |
| Number Of Medical Services | 10499 |
| Number Of Medicare Beneficiaries With Medical Services | 3260 |
| Total Medical Submitted Charge Amount | 946873.23 |
| Total Medical Medicare Allowed Amount | 294579.75 |
| Total Medical Medicare Payment Amount | 218849.91 |
| Total Medical Medicare Standardized Payment Amount | 233317.04 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 636 |
| Number Of Beneficiaries Age 65 to 74 | 1201 |
| Number Of Beneficiaries Age 75 to 84 | 907 |
| Number Of Beneficiaries Age Greater 84 | 516 |
| Number Of Female Beneficiaries | 2034 |
| Number Of Male Beneficiaries | 1226 |
| Number Of Non Hispanic White Beneficiaries | 3061 |
| Number Of Black or African American Beneficiaries | 113 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 37 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2612 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 648 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2193 |