| National Provider Identifier [NPI]: | 1134102668 |
| Last Name Of The Provider | MARRIOTT |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 62 GROGANS POINT RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | THE WOODLANDS |
| Zip Code Of The Provider | 773802620 |
| 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 | 173 |
| Number Of Services | 6561 |
| Number Of Medicare Beneficiaries | 3206 |
| Total Submitted Charge Amount | 625149 |
| Total Medicare Allowed Amount | 152244.09 |
| Total Medicare Payment Amount | 124039.66 |
| Total Medicare Standardized Payment Amount | 128808.88 |
| 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 | 173 |
| Number Of Medical Services | 6561 |
| Number Of Medicare Beneficiaries With Medical Services | 3206 |
| Total Medical Submitted Charge Amount | 625149 |
| Total Medical Medicare Allowed Amount | 152244.09 |
| Total Medical Medicare Payment Amount | 124039.66 |
| Total Medical Medicare Standardized Payment Amount | 128808.88 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 447 |
| Number Of Beneficiaries Age 65 to 74 | 1376 |
| Number Of Beneficiaries Age 75 to 84 | 965 |
| Number Of Beneficiaries Age Greater 84 | 418 |
| Number Of Female Beneficiaries | 2146 |
| Number Of Male Beneficiaries | 1060 |
| Number Of Non Hispanic White Beneficiaries | 2801 |
| Number Of Black or African American Beneficiaries | 212 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 149 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2569 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 637 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.6384 |