| National Provider Identifier [NPI]: | 1598724171 |
| Last Name Of The Provider | LEIBOLD |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2490 W 26TH AVE |
| Street Address 2 Of The Provider | SUITE 220 |
| City Of The Provider | DENVER |
| Zip Code Of The Provider | 802115314 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 156 |
| Number Of Services | 3999 |
| Number Of Medicare Beneficiaries | 2091 |
| Total Submitted Charge Amount | 604768.38 |
| Total Medicare Allowed Amount | 148256.7 |
| Total Medicare Payment Amount | 112440.85 |
| Total Medicare Standardized Payment Amount | 113758.51 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 1352 |
| Number Of Medicare Beneficiaries With Drug Services | 32 |
| Total Drug Submitted ChargeAmount | 1926.38 |
| Total Drug Medicare AllowedAmount | 868.6 |
| Total Drug Medicare PaymentAmount | 680.95 |
| Total Drug Medicare Standardized Payment Amount | 680.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 152 |
| Number Of Medical Services | 2647 |
| Number Of Medicare Beneficiaries With Medical Services | 2091 |
| Total Medical Submitted Charge Amount | 602842 |
| Total Medical Medicare Allowed Amount | 147388.1 |
| Total Medical Medicare Payment Amount | 111759.9 |
| Total Medical Medicare Standardized Payment Amount | 113077.56 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 380 |
| Number Of Beneficiaries Age 65 to 74 | 877 |
| Number Of Beneficiaries Age 75 to 84 | 529 |
| Number Of Beneficiaries Age Greater 84 | 305 |
| Number Of Female Beneficiaries | 1196 |
| Number Of Male Beneficiaries | 895 |
| Number Of Non Hispanic White Beneficiaries | 1754 |
| Number Of Black or African American Beneficiaries | 27 |
| Number Of AsianPacific Islander Beneficiaries | 44 |
| Number Of Hispanic Beneficiaries | 229 |
| Number Of American Indian Alaska Native Beneficiaries | 12 |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1632 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 459 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5289 |