| National Provider Identifier [NPI]: | 1659555993 |
| Last Name Of The Provider | FORD |
| First Name Of The Provider | JASON |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1111 RONALD REAGAN PKWY |
| Street Address 2 Of The Provider | RADIOLOGY RM 11078 |
| City Of The Provider | AVON |
| Zip Code Of The Provider | 461237085 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 139 |
| Number Of Services | 4804 |
| Number Of Medicare Beneficiaries | 2966 |
| Total Submitted Charge Amount | 424976 |
| Total Medicare Allowed Amount | 134902 |
| Total Medicare Payment Amount | 97936.08 |
| Total Medicare Standardized Payment Amount | 103119.35 |
| 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 | 139 |
| Number Of Medical Services | 4804 |
| Number Of Medicare Beneficiaries With Medical Services | 2966 |
| Total Medical Submitted Charge Amount | 424976 |
| Total Medical Medicare Allowed Amount | 134902 |
| Total Medical Medicare Payment Amount | 97936.08 |
| Total Medical Medicare Standardized Payment Amount | 103119.35 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 575 |
| Number Of Beneficiaries Age 65 to 74 | 1109 |
| Number Of Beneficiaries Age 75 to 84 | 789 |
| Number Of Beneficiaries Age Greater 84 | 493 |
| Number Of Female Beneficiaries | 1858 |
| Number Of Male Beneficiaries | 1108 |
| Number Of Non Hispanic White Beneficiaries | 2670 |
| Number Of Black or African American Beneficiaries | 203 |
| Number Of AsianPacific Islander Beneficiaries | 32 |
| Number Of Hispanic Beneficiaries | 36 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2253 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 713 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.7077 |