| National Provider Identifier [NPI]: | 1568430171 |
| Last Name Of The Provider | DEPENA |
| First Name Of The Provider | CHARLES |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 12368 STRATFORD DR |
| Street Address 2 Of The Provider | SUITE 300 |
| City Of The Provider | CLIVE |
| Zip Code Of The Provider | 503258162 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 128 |
| Number Of Services | 12989 |
| Number Of Medicare Beneficiaries | 1500 |
| Total Submitted Charge Amount | 1178197 |
| Total Medicare Allowed Amount | 298399.73 |
| Total Medicare Payment Amount | 230353.12 |
| Total Medicare Standardized Payment Amount | 252902.72 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 10383 |
| Number Of Medicare Beneficiaries With Drug Services | 148 |
| Total Drug Submitted ChargeAmount | 20182 |
| Total Drug Medicare AllowedAmount | 4981.49 |
| Total Drug Medicare PaymentAmount | 3891.26 |
| Total Drug Medicare Standardized Payment Amount | 3891.26 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 124 |
| Number Of Medical Services | 2606 |
| Number Of Medicare Beneficiaries With Medical Services | 1500 |
| Total Medical Submitted Charge Amount | 1158015 |
| Total Medical Medicare Allowed Amount | 293418.24 |
| Total Medical Medicare Payment Amount | 226461.86 |
| Total Medical Medicare Standardized Payment Amount | 249011.46 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 227 |
| Number Of Beneficiaries Age 65 to 74 | 583 |
| Number Of Beneficiaries Age 75 to 84 | 473 |
| Number Of Beneficiaries Age Greater 84 | 217 |
| Number Of Female Beneficiaries | 873 |
| Number Of Male Beneficiaries | 627 |
| Number Of Non Hispanic White Beneficiaries | 1413 |
| Number Of Black or African American Beneficiaries | 45 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 18 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1235 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 265 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 22 |
| Average HCC Risk Score Of Beneficiaries | 1.3569 |