| National Provider Identifier [NPI]: | 1396708244 |
| Last Name Of The Provider | COLVIN |
| First Name Of The Provider | OTIS |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 375 DIXMYTH AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CINCINNATI |
| Zip Code Of The Provider | 452202475 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 180 |
| Number Of Services | 4514 |
| Number Of Medicare Beneficiaries | 2227 |
| Total Submitted Charge Amount | 345765.95 |
| Total Medicare Allowed Amount | 125439.33 |
| Total Medicare Payment Amount | 93579.64 |
| Total Medicare Standardized Payment Amount | 100180.49 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 685 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 519.2 |
| Total Drug Medicare AllowedAmount | 498.86 |
| Total Drug Medicare PaymentAmount | 356.26 |
| Total Drug Medicare Standardized Payment Amount | 356.26 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 175 |
| Number Of Medical Services | 3829 |
| Number Of Medicare Beneficiaries With Medical Services | 2227 |
| Total Medical Submitted Charge Amount | 345246.75 |
| Total Medical Medicare Allowed Amount | 124940.47 |
| Total Medical Medicare Payment Amount | 93223.38 |
| Total Medical Medicare Standardized Payment Amount | 99824.23 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 422 |
| Number Of Beneficiaries Age 65 to 74 | 748 |
| Number Of Beneficiaries Age 75 to 84 | 698 |
| Number Of Beneficiaries Age Greater 84 | 359 |
| Number Of Female Beneficiaries | 1318 |
| Number Of Male Beneficiaries | 909 |
| Number Of Non Hispanic White Beneficiaries | 2048 |
| Number Of Black or African American Beneficiaries | 52 |
| Number Of AsianPacific Islander Beneficiaries | 18 |
| Number Of Hispanic Beneficiaries | 62 |
| Number Of American Indian Alaska Native Beneficiaries | 11 |
| Number Of Beneficiaries With Race Not Else where Classified | 36 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1671 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 556 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.5873 |