| National Provider Identifier [NPI]: | 1235162421 |
| Last Name Of The Provider | DEWYNGAERT |
| First Name Of The Provider | SUSAN |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 111 S 11TH ST |
| Street Address 2 Of The Provider | SUITE 3390 |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191074824 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 1923 |
| Number Of Medicare Beneficiaries | 967 |
| Total Submitted Charge Amount | 149976.74 |
| Total Medicare Allowed Amount | 49931.51 |
| Total Medicare Payment Amount | 42849.09 |
| Total Medicare Standardized Payment Amount | 41294.12 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
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| Number Of Medicare Beneficiaries With Medical Services | |
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| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 130 |
| Number Of Beneficiaries Age 65 to 74 | 567 |
| Number Of Beneficiaries Age 75 to 84 | 212 |
| Number Of Beneficiaries Age Greater 84 | 58 |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| Number Of Non Hispanic White Beneficiaries | 650 |
| Number Of Black or African American Beneficiaries | 232 |
| Number Of AsianPacific Islander Beneficiaries | 46 |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 800 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 167 |
| Percent Of With Atrial Fibrillation | 4 |
| Percent Of With Alzheimers Disease or Dementia | 3 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9156 |