| National Provider Identifier [NPI]: | 1710952155 |
| Last Name Of The Provider | BONSACK |
| First Name Of The Provider | TIMOTHY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4516 N ARMENIA AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | TAMPA |
| Zip Code Of The Provider | 336032732 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 165 |
| Number Of Services | 5999 |
| Number Of Medicare Beneficiaries | 2801 |
| Total Submitted Charge Amount | 572941.49 |
| Total Medicare Allowed Amount | 152738.23 |
| Total Medicare Payment Amount | 117750.63 |
| Total Medicare Standardized Payment Amount | 118499.2 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 2000 |
| Number Of Medicare Beneficiaries With Drug Services | 22 |
| Total Drug Submitted ChargeAmount | 5523 |
| Total Drug Medicare AllowedAmount | 435.15 |
| Total Drug Medicare PaymentAmount | 327.55 |
| Total Drug Medicare Standardized Payment Amount | 327.55 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 163 |
| Number Of Medical Services | 3999 |
| Number Of Medicare Beneficiaries With Medical Services | 2800 |
| Total Medical Submitted Charge Amount | 567418.49 |
| Total Medical Medicare Allowed Amount | 152303.08 |
| Total Medical Medicare Payment Amount | 117423.08 |
| Total Medical Medicare Standardized Payment Amount | 118171.65 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 499 |
| Number Of Beneficiaries Age 65 to 74 | 889 |
| Number Of Beneficiaries Age 75 to 84 | 840 |
| Number Of Beneficiaries Age Greater 84 | 573 |
| Number Of Female Beneficiaries | 1738 |
| Number Of Male Beneficiaries | 1063 |
| Number Of Non Hispanic White Beneficiaries | 1853 |
| Number Of Black or African American Beneficiaries | 349 |
| Number Of AsianPacific Islander Beneficiaries | 45 |
| Number Of Hispanic Beneficiaries | 539 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1771 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1030 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 32 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.1663 |