| National Provider Identifier [NPI]: | 1770504318 |
| Last Name Of The Provider | D'SOUZA |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3900 SUNFOREST CT STE 136 |
| Street Address 2 Of The Provider | |
| City Of The Provider | TOLEDO |
| Zip Code Of The Provider | 436234440 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 171 |
| Number Of Services | 2441 |
| Number Of Medicare Beneficiaries | 1218 |
| Total Submitted Charge Amount | 292352 |
| Total Medicare Allowed Amount | 74882.09 |
| Total Medicare Payment Amount | 55304.89 |
| Total Medicare Standardized Payment Amount | 57005.36 |
| 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 | 171 |
| Number Of Medical Services | 2441 |
| Number Of Medicare Beneficiaries With Medical Services | 1218 |
| Total Medical Submitted Charge Amount | 292352 |
| Total Medical Medicare Allowed Amount | 74882.09 |
| Total Medical Medicare Payment Amount | 55304.89 |
| Total Medical Medicare Standardized Payment Amount | 57005.36 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 329 |
| Number Of Beneficiaries Age 65 to 74 | 437 |
| Number Of Beneficiaries Age 75 to 84 | 266 |
| Number Of Beneficiaries Age Greater 84 | 186 |
| Number Of Female Beneficiaries | 744 |
| Number Of Male Beneficiaries | 474 |
| Number Of Non Hispanic White Beneficiaries | 1128 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 48 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 871 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 347 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.3259 |