| National Provider Identifier [NPI]: | 1922083351 |
| Last Name Of The Provider | DESJARDINS |
| First Name Of The Provider | BENOIT |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3400 SPRUCE ST |
| Street Address 2 Of The Provider | 1 DONNER |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191044283 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 3460 |
| Number Of Medicare Beneficiaries | 2244 |
| Total Submitted Charge Amount | 408311 |
| Total Medicare Allowed Amount | 127169.25 |
| Total Medicare Payment Amount | 97378.85 |
| Total Medicare Standardized Payment Amount | 95049.22 |
| 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 | 49 |
| Number Of Medical Services | 3460 |
| Number Of Medicare Beneficiaries With Medical Services | 2244 |
| Total Medical Submitted Charge Amount | 408311 |
| Total Medical Medicare Allowed Amount | 127169.25 |
| Total Medical Medicare Payment Amount | 97378.85 |
| Total Medical Medicare Standardized Payment Amount | 95049.22 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 458 |
| Number Of Beneficiaries Age 65 to 74 | 882 |
| Number Of Beneficiaries Age 75 to 84 | 604 |
| Number Of Beneficiaries Age Greater 84 | 300 |
| Number Of Female Beneficiaries | 992 |
| Number Of Male Beneficiaries | 1252 |
| Number Of Non Hispanic White Beneficiaries | 1483 |
| Number Of Black or African American Beneficiaries | 643 |
| Number Of AsianPacific Islander Beneficiaries | 43 |
| Number Of Hispanic Beneficiaries | 34 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 41 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1650 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 594 |
| Percent Of With Atrial Fibrillation | 35 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 60 |
| Percent Of With Chronic Kidney Disease | 55 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 70 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.3766 |