| National Provider Identifier [NPI]: | 1609801711 |
| Last Name Of The Provider | DONTA |
| First Name Of The Provider | THEODORE |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD PH D |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1948 1ST AVE NE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CEDAR RAPIDS |
| Zip Code Of The Provider | 524025321 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 160 |
| Number Of Services | 7340 |
| Number Of Medicare Beneficiaries | 4869 |
| Total Submitted Charge Amount | 640974.04 |
| Total Medicare Allowed Amount | 184511.58 |
| Total Medicare Payment Amount | 142356.54 |
| Total Medicare Standardized Payment Amount | 151369.34 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 780 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 776.25 |
| Total Drug Medicare AllowedAmount | 330.41 |
| Total Drug Medicare PaymentAmount | 259.03 |
| Total Drug Medicare Standardized Payment Amount | 259.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 158 |
| Number Of Medical Services | 6560 |
| Number Of Medicare Beneficiaries With Medical Services | 4869 |
| Total Medical Submitted Charge Amount | 640197.79 |
| Total Medical Medicare Allowed Amount | 184181.17 |
| Total Medical Medicare Payment Amount | 142097.51 |
| Total Medical Medicare Standardized Payment Amount | 151110.31 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 783 |
| Number Of Beneficiaries Age 65 to 74 | 1676 |
| Number Of Beneficiaries Age 75 to 84 | 1517 |
| Number Of Beneficiaries Age Greater 84 | 893 |
| Number Of Female Beneficiaries | 2979 |
| Number Of Male Beneficiaries | 1890 |
| Number Of Non Hispanic White Beneficiaries | 4682 |
| Number Of Black or African American Beneficiaries | 101 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 24 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 45 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3776 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1093 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.3872 |