| National Provider Identifier [NPI]: | 1568426385 |
| Last Name Of The Provider | LOGAN |
| First Name Of The Provider | DONALD |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 703 RIVERWAY PL |
| Street Address 2 Of The Provider | |
| City Of The Provider | BEDFORD |
| Zip Code Of The Provider | 031106768 |
| State Code Of The Provider | NH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 225 |
| Number Of Services | 7081 |
| Number Of Medicare Beneficiaries | 4593 |
| Total Submitted Charge Amount | 614439 |
| Total Medicare Allowed Amount | 191874.53 |
| Total Medicare Payment Amount | 146309.89 |
| Total Medicare Standardized Payment Amount | 146116.7 |
| 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 | 225 |
| Number Of Medical Services | 7081 |
| Number Of Medicare Beneficiaries With Medical Services | 4593 |
| Total Medical Submitted Charge Amount | 614439 |
| Total Medical Medicare Allowed Amount | 191874.53 |
| Total Medical Medicare Payment Amount | 146309.89 |
| Total Medical Medicare Standardized Payment Amount | 146116.7 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 879 |
| Number Of Beneficiaries Age 65 to 74 | 1586 |
| Number Of Beneficiaries Age 75 to 84 | 1338 |
| Number Of Beneficiaries Age Greater 84 | 790 |
| Number Of Female Beneficiaries | 2733 |
| Number Of Male Beneficiaries | 1860 |
| Number Of Non Hispanic White Beneficiaries | 4390 |
| Number Of Black or African American Beneficiaries | 38 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 80 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 57 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3590 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1003 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.4956 |