| National Provider Identifier [NPI]: | 1235154840 |
| Last Name Of The Provider | NOTARNICOLA |
| First Name Of The Provider | JON-ERIC |
| 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 | 3264 N EVERGREEN DR NE |
| Street Address 2 Of The Provider | |
| City Of The Provider | GRAND RAPIDS |
| Zip Code Of The Provider | 495259746 |
| 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 | 120 |
| Number Of Services | 3625 |
| Number Of Medicare Beneficiaries | 2491 |
| Total Submitted Charge Amount | 300077 |
| Total Medicare Allowed Amount | 85912.71 |
| Total Medicare Payment Amount | 69065.85 |
| Total Medicare Standardized Payment Amount | 70839.66 |
| 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 | 120 |
| Number Of Medical Services | 3625 |
| Number Of Medicare Beneficiaries With Medical Services | 2491 |
| Total Medical Submitted Charge Amount | 300077 |
| Total Medical Medicare Allowed Amount | 85912.71 |
| Total Medical Medicare Payment Amount | 69065.85 |
| Total Medical Medicare Standardized Payment Amount | 70839.66 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 594 |
| Number Of Beneficiaries Age 65 to 74 | 882 |
| Number Of Beneficiaries Age 75 to 84 | 679 |
| Number Of Beneficiaries Age Greater 84 | 336 |
| Number Of Female Beneficiaries | 1744 |
| Number Of Male Beneficiaries | 747 |
| Number Of Non Hispanic White Beneficiaries | 2188 |
| Number Of Black or African American Beneficiaries | 178 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 73 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1726 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 765 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.5329 |