| National Provider Identifier [NPI]: | 1942497730 |
| Last Name Of The Provider | BRUDVIK |
| First Name Of The Provider | ANDREA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3601 W 13 MILE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | ROYAL OAK |
| Zip Code Of The Provider | 480736712 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 2674 |
| Number Of Medicare Beneficiaries | 1246 |
| Total Submitted Charge Amount | 152498 |
| Total Medicare Allowed Amount | 68628.71 |
| Total Medicare Payment Amount | 59349.55 |
| Total Medicare Standardized Payment Amount | 56929.68 |
| 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 | 23 |
| Number Of Medical Services | 2674 |
| Number Of Medicare Beneficiaries With Medical Services | 1246 |
| Total Medical Submitted Charge Amount | 152498 |
| Total Medical Medicare Allowed Amount | 68628.71 |
| Total Medical Medicare Payment Amount | 59349.55 |
| Total Medical Medicare Standardized Payment Amount | 56929.68 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 145 |
| Number Of Beneficiaries Age 65 to 74 | 673 |
| Number Of Beneficiaries Age 75 to 84 | 352 |
| Number Of Beneficiaries Age Greater 84 | 76 |
| Number Of Female Beneficiaries | 1235 |
| Number Of Male Beneficiaries | 11 |
| Number Of Non Hispanic White Beneficiaries | 975 |
| Number Of Black or African American Beneficiaries | 212 |
| Number Of AsianPacific Islander Beneficiaries | 21 |
| Number Of Hispanic Beneficiaries | 11 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 27 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1097 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 149 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 11 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9291 |