| National Provider Identifier [NPI]: | 1477590560 |
| Last Name Of The Provider | COSTELLO |
| First Name Of The Provider | THOMAS |
| 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 | 2020 PALOMINO LN |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | LAS VEGAS |
| Zip Code Of The Provider | 891064894 |
| State Code Of The Provider | NV |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 233 |
| Number Of Services | 36239 |
| Number Of Medicare Beneficiaries | 4041 |
| Total Submitted Charge Amount | 2132425.65 |
| Total Medicare Allowed Amount | 501685.31 |
| Total Medicare Payment Amount | 387669.91 |
| Total Medicare Standardized Payment Amount | 378614.7 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 30527 |
| Number Of Medicare Beneficiaries With Drug Services | 354 |
| Total Drug Submitted ChargeAmount | 81947.53 |
| Total Drug Medicare AllowedAmount | 7817.81 |
| Total Drug Medicare PaymentAmount | 6124.42 |
| Total Drug Medicare Standardized Payment Amount | 6124.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 225 |
| Number Of Medical Services | 5712 |
| Number Of Medicare Beneficiaries With Medical Services | 4039 |
| Total Medical Submitted Charge Amount | 2050478.12 |
| Total Medical Medicare Allowed Amount | 493867.5 |
| Total Medical Medicare Payment Amount | 381545.49 |
| Total Medical Medicare Standardized Payment Amount | 372490.28 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 589 |
| Number Of Beneficiaries Age 65 to 74 | 1881 |
| Number Of Beneficiaries Age 75 to 84 | 1163 |
| Number Of Beneficiaries Age Greater 84 | 408 |
| Number Of Female Beneficiaries | 2572 |
| Number Of Male Beneficiaries | 1469 |
| Number Of Non Hispanic White Beneficiaries | 3078 |
| Number Of Black or African American Beneficiaries | 413 |
| Number Of AsianPacific Islander Beneficiaries | 150 |
| Number Of Hispanic Beneficiaries | 313 |
| Number Of American Indian Alaska Native Beneficiaries | 13 |
| Number Of Beneficiaries With Race Not Else where Classified | 74 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3334 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 707 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.4735 |