| National Provider Identifier [NPI]: | 1972527323 |
| Last Name Of The Provider | VOTRUBA |
| First Name Of The Provider | MICHAEL |
| 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 | 200 JEFFESON SE |
| Street Address 2 Of The Provider | |
| City Of The Provider | GRAND RAPIDS |
| Zip Code Of The Provider | 49503 |
| 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 | 165 |
| Number Of Services | 2702 |
| Number Of Medicare Beneficiaries | 1818 |
| Total Submitted Charge Amount | 257553 |
| Total Medicare Allowed Amount | 82653.26 |
| Total Medicare Payment Amount | 63637.97 |
| Total Medicare Standardized Payment Amount | 66097.71 |
| 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 | 165 |
| Number Of Medical Services | 2702 |
| Number Of Medicare Beneficiaries With Medical Services | 1818 |
| Total Medical Submitted Charge Amount | 257553 |
| Total Medical Medicare Allowed Amount | 82653.26 |
| Total Medical Medicare Payment Amount | 63637.97 |
| Total Medical Medicare Standardized Payment Amount | 66097.71 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 627 |
| Number Of Beneficiaries Age 65 to 74 | 536 |
| Number Of Beneficiaries Age 75 to 84 | 397 |
| Number Of Beneficiaries Age Greater 84 | 258 |
| Number Of Female Beneficiaries | 1012 |
| Number Of Male Beneficiaries | 806 |
| Number Of Non Hispanic White Beneficiaries | 1407 |
| Number Of Black or African American Beneficiaries | 274 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 95 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1098 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 720 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.0103 |