| National Provider Identifier [NPI]: | 1659384899 |
| Last Name Of The Provider | HALSTED |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 CHILDRENS PLZ |
| Street Address 2 Of The Provider | ATTN: RADIOLOGY DEPARTMENT |
| City Of The Provider | DAYTON |
| Zip Code Of The Provider | 454041873 |
| 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 | 101 |
| Number Of Services | 1320 |
| Number Of Medicare Beneficiaries | 813 |
| Total Submitted Charge Amount | 147909 |
| Total Medicare Allowed Amount | 47128.48 |
| Total Medicare Payment Amount | 36823.09 |
| Total Medicare Standardized Payment Amount | 37862.6 |
| 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 | 101 |
| Number Of Medical Services | 1320 |
| Number Of Medicare Beneficiaries With Medical Services | 813 |
| Total Medical Submitted Charge Amount | 147909 |
| Total Medical Medicare Allowed Amount | 47128.48 |
| Total Medical Medicare Payment Amount | 36823.09 |
| Total Medical Medicare Standardized Payment Amount | 37862.6 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 111 |
| Number Of Beneficiaries Age 65 to 74 | 226 |
| Number Of Beneficiaries Age 75 to 84 | 270 |
| Number Of Beneficiaries Age Greater 84 | 206 |
| Number Of Female Beneficiaries | 473 |
| Number Of Male Beneficiaries | 340 |
| Number Of Non Hispanic White Beneficiaries | 699 |
| Number Of Black or African American Beneficiaries | 65 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 579 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 234 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 1.7963 |