| National Provider Identifier [NPI]: | 1538249420 |
| Last Name Of The Provider | DONG |
| First Name Of The Provider | QIAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | BM |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1500 EAST MEDICAL CENTER DR |
| Street Address 2 Of The Provider | 2ND FLOOR TAUBMAN CTR RECP A |
| City Of The Provider | ANN ARBOR |
| Zip Code Of The Provider | 481095326 |
| 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 | 107 |
| Number Of Services | 2511 |
| Number Of Medicare Beneficiaries | 1586 |
| Total Submitted Charge Amount | 211195 |
| Total Medicare Allowed Amount | 49521.74 |
| Total Medicare Payment Amount | 35191.59 |
| Total Medicare Standardized Payment Amount | 34200.43 |
| 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 | 107 |
| Number Of Medical Services | 2511 |
| Number Of Medicare Beneficiaries With Medical Services | 1586 |
| Total Medical Submitted Charge Amount | 211195 |
| Total Medical Medicare Allowed Amount | 49521.74 |
| Total Medical Medicare Payment Amount | 35191.59 |
| Total Medical Medicare Standardized Payment Amount | 34200.43 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 405 |
| Number Of Beneficiaries Age 65 to 74 | 684 |
| Number Of Beneficiaries Age 75 to 84 | 357 |
| Number Of Beneficiaries Age Greater 84 | 140 |
| Number Of Female Beneficiaries | 959 |
| Number Of Male Beneficiaries | 627 |
| Number Of Non Hispanic White Beneficiaries | 1300 |
| Number Of Black or African American Beneficiaries | 174 |
| Number Of AsianPacific Islander Beneficiaries | 40 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 37 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1237 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 349 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.5639 |