| National Provider Identifier [NPI]: | 1447238050 |
| Last Name Of The Provider | GRIMM |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4001 FAIR RIDGE DR |
| Street Address 2 Of The Provider | #103, FAIR OAKS IMAGING CENTER |
| City Of The Provider | FAIRFAX |
| Zip Code Of The Provider | 220332917 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 210 |
| Number Of Services | 5112 |
| Number Of Medicare Beneficiaries | 1545 |
| Total Submitted Charge Amount | 827439 |
| Total Medicare Allowed Amount | 193113.87 |
| Total Medicare Payment Amount | 150490.58 |
| Total Medicare Standardized Payment Amount | 134792.52 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 2100 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 1050 |
| Total Drug Medicare AllowedAmount | 390.5 |
| Total Drug Medicare PaymentAmount | 306.14 |
| Total Drug Medicare Standardized Payment Amount | 306.14 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 209 |
| Number Of Medical Services | 3012 |
| Number Of Medicare Beneficiaries With Medical Services | 1545 |
| Total Medical Submitted Charge Amount | 826389 |
| Total Medical Medicare Allowed Amount | 192723.37 |
| Total Medical Medicare Payment Amount | 150184.44 |
| Total Medical Medicare Standardized Payment Amount | 134486.38 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 151 |
| Number Of Beneficiaries Age 65 to 74 | 668 |
| Number Of Beneficiaries Age 75 to 84 | 483 |
| Number Of Beneficiaries Age Greater 84 | 243 |
| Number Of Female Beneficiaries | 968 |
| Number Of Male Beneficiaries | 577 |
| Number Of Non Hispanic White Beneficiaries | 1176 |
| Number Of Black or African American Beneficiaries | 117 |
| Number Of AsianPacific Islander Beneficiaries | 142 |
| Number Of Hispanic Beneficiaries | 60 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1332 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 213 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.4531 |