| National Provider Identifier [NPI]: | 1033268578 |
| Last Name Of The Provider | LEWIS |
| First Name Of The Provider | SAMUEL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11335 ALTAMONT DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | FRISCO |
| Zip Code Of The Provider | 750341182 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nuclear Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 1 |
| Number Of Services | 349 |
| Number Of Medicare Beneficiaries | 348 |
| Total Submitted Charge Amount | 139600 |
| Total Medicare Allowed Amount | 27176.63 |
| Total Medicare Payment Amount | 21306.45 |
| Total Medicare Standardized Payment Amount | 21733.05 |
| 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 | 1 |
| Number Of Medical Services | 349 |
| Number Of Medicare Beneficiaries With Medical Services | 348 |
| Total Medical Submitted Charge Amount | 139600 |
| Total Medical Medicare Allowed Amount | 27176.63 |
| Total Medical Medicare Payment Amount | 21306.45 |
| Total Medical Medicare Standardized Payment Amount | 21733.05 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 54 |
| Number Of Beneficiaries Age 65 to 74 | 140 |
| Number Of Beneficiaries Age 75 to 84 | 123 |
| Number Of Beneficiaries Age Greater 84 | 31 |
| Number Of Female Beneficiaries | 155 |
| Number Of Male Beneficiaries | 193 |
| Number Of Non Hispanic White Beneficiaries | 188 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 120 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 241 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 107 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 55 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.5906 |