| National Provider Identifier [NPI]: | 1063518660 |
| Last Name Of The Provider | WEBSTER |
| First Name Of The Provider | GLENN |
| 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 | 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 | 119 |
| Number Of Services | 2224 |
| Number Of Medicare Beneficiaries | 1412 |
| Total Submitted Charge Amount | 258372 |
| Total Medicare Allowed Amount | 67737.85 |
| Total Medicare Payment Amount | 52952.48 |
| Total Medicare Standardized Payment Amount | 51529.65 |
| 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 | 119 |
| Number Of Medical Services | 2224 |
| Number Of Medicare Beneficiaries With Medical Services | 1412 |
| Total Medical Submitted Charge Amount | 258372 |
| Total Medical Medicare Allowed Amount | 67737.85 |
| Total Medical Medicare Payment Amount | 52952.48 |
| Total Medical Medicare Standardized Payment Amount | 51529.65 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 479 |
| Number Of Beneficiaries Age 65 to 74 | 435 |
| Number Of Beneficiaries Age 75 to 84 | 303 |
| Number Of Beneficiaries Age Greater 84 | 195 |
| Number Of Female Beneficiaries | 837 |
| Number Of Male Beneficiaries | 575 |
| Number Of Non Hispanic White Beneficiaries | 71 |
| Number Of Black or African American Beneficiaries | 1328 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 595 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 817 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 35 |
| Percent Of With Asthma | 24 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 62 |
| Percent Of With Chronic Kidney Disease | 60 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 47 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 66 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 72 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 65 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 15 |
| Percent Of With Stroke | 24 |
| Average HCC Risk Score Of Beneficiaries | 3.1425 |