| National Provider Identifier [NPI]: | 1487644902 |
| Last Name Of The Provider | BLACK |
| First Name Of The Provider | RICHARD |
| 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 | 65 SOCKANOSSET CROSSROADS |
| Street Address 2 Of The Provider | |
| City Of The Provider | CRANSTON |
| Zip Code Of The Provider | 029206068 |
| State Code Of The Provider | RI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 188 |
| Number Of Services | 10523 |
| Number Of Medicare Beneficiaries | 4742 |
| Total Submitted Charge Amount | 1163777 |
| Total Medicare Allowed Amount | 249228.16 |
| Total Medicare Payment Amount | 195534.4 |
| Total Medicare Standardized Payment Amount | 191856.47 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 2330 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 2591 |
| Total Drug Medicare AllowedAmount | 717.13 |
| Total Drug Medicare PaymentAmount | 562.24 |
| Total Drug Medicare Standardized Payment Amount | 562.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 186 |
| Number Of Medical Services | 8193 |
| Number Of Medicare Beneficiaries With Medical Services | 4742 |
| Total Medical Submitted Charge Amount | 1161186 |
| Total Medical Medicare Allowed Amount | 248511.03 |
| Total Medical Medicare Payment Amount | 194972.16 |
| Total Medical Medicare Standardized Payment Amount | 191294.23 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 932 |
| Number Of Beneficiaries Age 65 to 74 | 1711 |
| Number Of Beneficiaries Age 75 to 84 | 1182 |
| Number Of Beneficiaries Age Greater 84 | 917 |
| Number Of Female Beneficiaries | 3134 |
| Number Of Male Beneficiaries | 1608 |
| Number Of Non Hispanic White Beneficiaries | 4399 |
| Number Of Black or African American Beneficiaries | 73 |
| Number Of AsianPacific Islander Beneficiaries | 16 |
| Number Of Hispanic Beneficiaries | 151 |
| Number Of American Indian Alaska Native Beneficiaries | 35 |
| Number Of Beneficiaries With Race Not Else where Classified | 68 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3463 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1279 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5253 |