| National Provider Identifier [NPI]: | 1609067750 |
| Last Name Of The Provider | SMITH |
| First Name Of The Provider | TALETHA |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1515 HOLCOMBE BLVD |
| Street Address 2 Of The Provider | DIVISION OF DIAGNOSTIC IMAGING |
| City Of The Provider | HOUSTON |
| Zip Code Of The Provider | 770304000 |
| 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 | 203 |
| Number Of Services | 11795 |
| Number Of Medicare Beneficiaries | 5891 |
| Total Submitted Charge Amount | 1531148 |
| Total Medicare Allowed Amount | 312372.99 |
| Total Medicare Payment Amount | 238265.84 |
| Total Medicare Standardized Payment Amount | 255078.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 200 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 1000 |
| Total Drug Medicare AllowedAmount | 393.71 |
| Total Drug Medicare PaymentAmount | 290.26 |
| Total Drug Medicare Standardized Payment Amount | 290.26 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 202 |
| Number Of Medical Services | 11595 |
| Number Of Medicare Beneficiaries With Medical Services | 5891 |
| Total Medical Submitted Charge Amount | 1530148 |
| Total Medical Medicare Allowed Amount | 311979.28 |
| Total Medical Medicare Payment Amount | 237975.58 |
| Total Medical Medicare Standardized Payment Amount | 254788.11 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 1281 |
| Number Of Beneficiaries Age 65 to 74 | 2075 |
| Number Of Beneficiaries Age 75 to 84 | 1761 |
| Number Of Beneficiaries Age Greater 84 | 774 |
| Number Of Female Beneficiaries | 3797 |
| Number Of Male Beneficiaries | 2094 |
| Number Of Non Hispanic White Beneficiaries | 4027 |
| Number Of Black or African American Beneficiaries | 1740 |
| Number Of AsianPacific Islander Beneficiaries | 11 |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | 85 |
| Number Of Beneficiaries With Race Not Else where Classified | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3783 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 2108 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5492 |