| National Provider Identifier [NPI]: | 1881600534 |
| Last Name Of The Provider | ANDERSON |
| First Name Of The Provider | DIANE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | DO |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2222 PHILADELPHIA DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | DAYTON |
| Zip Code Of The Provider | 454061813 |
| 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 | 136 |
| Number Of Services | 4275 |
| Number Of Medicare Beneficiaries | 2471 |
| Total Submitted Charge Amount | 429870 |
| Total Medicare Allowed Amount | 109981.97 |
| Total Medicare Payment Amount | 89320.17 |
| Total Medicare Standardized Payment Amount | 91754.84 |
| 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 | 136 |
| Number Of Medical Services | 4275 |
| Number Of Medicare Beneficiaries With Medical Services | 2471 |
| Total Medical Submitted Charge Amount | 429870 |
| Total Medical Medicare Allowed Amount | 109981.97 |
| Total Medical Medicare Payment Amount | 89320.17 |
| Total Medical Medicare Standardized Payment Amount | 91754.84 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 453 |
| Number Of Beneficiaries Age 65 to 74 | 1076 |
| Number Of Beneficiaries Age 75 to 84 | 655 |
| Number Of Beneficiaries Age Greater 84 | 287 |
| Number Of Female Beneficiaries | 1894 |
| Number Of Male Beneficiaries | 577 |
| Number Of Non Hispanic White Beneficiaries | 1731 |
| Number Of Black or African American Beneficiaries | 697 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1890 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 581 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5212 |