| National Provider Identifier [NPI]: |
1477547222 |
| Last Name Of The Provider |
MAIL |
| First Name Of The Provider |
JOHN |
| Middle Initial Of The Provider |
T |
| Credentials Of The Provider |
MD |
| Gender Of The Provider |
M |
| Entity Type Of The Provider |
I |
| Street Address 1 Of The Provider |
7340 SHADELAND STATION |
| Street Address 2 Of The Provider |
SUITE 200 |
| City Of The Provider |
INDIANAPOLIS |
| Zip Code Of The Provider |
462563980 |
| 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 |
244 |
| Number Of Services |
3276 |
| Number Of Medicare Beneficiaries |
1927 |
| Total Submitted Charge Amount |
856680.8 |
| Total Medicare Allowed Amount |
191352.94 |
| Total Medicare Payment Amount |
146083.76 |
| Total Medicare Standardized Payment Amount |
156862.24 |
| 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 |
244 |
| Number Of Medical Services |
3276 |
| Number Of Medicare Beneficiaries With Medical Services |
1927 |
| Total Medical Submitted Charge Amount |
856680.8 |
| Total Medical Medicare Allowed Amount |
191352.94 |
| Total Medical Medicare Payment Amount |
146083.76 |
| Total Medical Medicare Standardized Payment Amount |
156862.24 |
| Average Age Of Beneficiaries |
73 |
| Number Of Beneficiaries Age Less65 |
349 |
| Number Of Beneficiaries Age 65 to 74 |
675 |
| Number Of Beneficiaries Age 75 to 84 |
567 |
| Number Of Beneficiaries Age Greater 84 |
336 |
| Number Of Female Beneficiaries |
1131 |
| Number Of Male Beneficiaries |
796 |
| Number Of Non Hispanic White Beneficiaries |
1855 |
| Number Of Black or African American Beneficiaries |
23 |
| Number Of AsianPacific Islander Beneficiaries |
|
| Number Of Hispanic Beneficiaries |
13 |
| Number Of American Indian Alaska Native Beneficiaries |
|
| Number Of Beneficiaries With Race Not Else where Classified |
20 |
| Number Of Beneficiaries With Medicare Only Entitlement |
1393 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement |
534 |
| Percent Of With Atrial Fibrillation |
19 |
| Percent Of With Alzheimers Disease or Dementia |
18 |
| Percent Of With Asthma |
11 |
| Percent Of With Cancer |
15 |
| Percent Of With Heart Failure |
37 |
| Percent Of With Chronic Kidney Disease |
44 |
| Percent Of With Chronic Obstructive Pulmonary Disease |
34 |
| Percent Of With Depression |
35 |
| Percent Of With Diabetes |
43 |
| Percent Of With Hyperlipidemia |
65 |
| Percent Of With Hypertension |
75 |
| Percent Of With Ischemic Heart Disease |
49 |
| Percent Of With Osteoporosis |
13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis |
46 |
| Percent Of With Schizophrenia Other PsychoticDisorders |
10 |
| Percent Of With Stroke |
13 |
| Average HCC Risk Score Of Beneficiaries |
1.96 |