| National Provider Identifier [NPI]: | 1720248529 |
| Last Name Of The Provider | CHRONISTER |
| First Name Of The Provider | JUSTIN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 14720 4TH ST |
| Street Address 2 Of The Provider | APT. 309 |
| City Of The Provider | LAUREL |
| Zip Code Of The Provider | 207073703 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 19 |
| Number Of Services | 2041 |
| Number Of Medicare Beneficiaries | 553 |
| Total Submitted Charge Amount | 448097 |
| Total Medicare Allowed Amount | 219131.18 |
| Total Medicare Payment Amount | 170885.91 |
| Total Medicare Standardized Payment Amount | 176943.44 |
| 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 | 19 |
| Number Of Medical Services | 2041 |
| Number Of Medicare Beneficiaries With Medical Services | 553 |
| Total Medical Submitted Charge Amount | 448097 |
| Total Medical Medicare Allowed Amount | 219131.18 |
| Total Medical Medicare Payment Amount | 170885.91 |
| Total Medical Medicare Standardized Payment Amount | 176943.44 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 120 |
| Number Of Beneficiaries Age 65 to 74 | 134 |
| Number Of Beneficiaries Age 75 to 84 | 159 |
| Number Of Beneficiaries Age Greater 84 | 140 |
| Number Of Female Beneficiaries | 275 |
| Number Of Male Beneficiaries | 278 |
| Number Of Non Hispanic White Beneficiaries | 255 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 264 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 281 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 272 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 45 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 61 |
| Percent Of With Chronic Kidney Disease | 69 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 43 |
| Percent Of With Depression | 48 |
| Percent Of With Diabetes | 65 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 68 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 21 |
| Average HCC Risk Score Of Beneficiaries | 3.233 |