| National Provider Identifier [NPI]: | 1265470421 |
| Last Name Of The Provider | CARROLL |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3623 LATROBE DRIVE |
| Street Address 2 Of The Provider | STE 216 |
| City Of The Provider | CHARLOTTE |
| Zip Code Of The Provider | 282118005 |
| State Code Of The Provider | NC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 147 |
| Number Of Services | 2936 |
| Number Of Medicare Beneficiaries | 2425 |
| Total Submitted Charge Amount | 641848 |
| Total Medicare Allowed Amount | 145262.56 |
| Total Medicare Payment Amount | 112952.55 |
| Total Medicare Standardized Payment Amount | 119032.03 |
| 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 | 147 |
| Number Of Medical Services | 2936 |
| Number Of Medicare Beneficiaries With Medical Services | 2425 |
| Total Medical Submitted Charge Amount | 641848 |
| Total Medical Medicare Allowed Amount | 145262.56 |
| Total Medical Medicare Payment Amount | 112952.55 |
| Total Medical Medicare Standardized Payment Amount | 119032.03 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 426 |
| Number Of Beneficiaries Age 65 to 74 | 1025 |
| Number Of Beneficiaries Age 75 to 84 | 663 |
| Number Of Beneficiaries Age Greater 84 | 311 |
| Number Of Female Beneficiaries | 1497 |
| Number Of Male Beneficiaries | 928 |
| Number Of Non Hispanic White Beneficiaries | 1939 |
| Number Of Black or African American Beneficiaries | 385 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 49 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 30 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1979 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 446 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.4168 |