| National Provider Identifier [NPI]: | 1962683029 |
| Last Name Of The Provider | LOPEZ |
| First Name Of The Provider | CAITLIN |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5333 MCAULEY DR |
| Street Address 2 Of The Provider | SUITE 6016 |
| City Of The Provider | YPSILANTI |
| Zip Code Of The Provider | 481971014 |
| 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 | 123 |
| Number Of Services | 7707 |
| Number Of Medicare Beneficiaries | 4771 |
| Total Submitted Charge Amount | 480336 |
| Total Medicare Allowed Amount | 182433.94 |
| Total Medicare Payment Amount | 145770.76 |
| Total Medicare Standardized Payment Amount | 141542.57 |
| 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 | 123 |
| Number Of Medical Services | 7707 |
| Number Of Medicare Beneficiaries With Medical Services | 4771 |
| Total Medical Submitted Charge Amount | 480336 |
| Total Medical Medicare Allowed Amount | 182433.94 |
| Total Medical Medicare Payment Amount | 145770.76 |
| Total Medical Medicare Standardized Payment Amount | 141542.57 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 768 |
| Number Of Beneficiaries Age 65 to 74 | 1810 |
| Number Of Beneficiaries Age 75 to 84 | 1357 |
| Number Of Beneficiaries Age Greater 84 | 836 |
| Number Of Female Beneficiaries | 3412 |
| Number Of Male Beneficiaries | 1359 |
| Number Of Non Hispanic White Beneficiaries | 4134 |
| Number Of Black or African American Beneficiaries | 440 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 77 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 60 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3911 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 860 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6217 |