| National Provider Identifier [NPI]: | 1164416475 |
| Last Name Of The Provider | DIVENS |
| First Name Of The Provider | TIMOTHY |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7340 SHADELAND STATION |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | INDIANAPOLIS |
| Zip Code Of The Provider | 462563980 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 138 |
| Number Of Services | 7521 |
| Number Of Medicare Beneficiaries | 4626 |
| Total Submitted Charge Amount | 648540 |
| Total Medicare Allowed Amount | 186621.47 |
| Total Medicare Payment Amount | 153913.44 |
| Total Medicare Standardized Payment Amount | 164644.47 |
| 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 | 138 |
| Number Of Medical Services | 7521 |
| Number Of Medicare Beneficiaries With Medical Services | 4626 |
| Total Medical Submitted Charge Amount | 648540 |
| Total Medical Medicare Allowed Amount | 186621.47 |
| Total Medical Medicare Payment Amount | 153913.44 |
| Total Medical Medicare Standardized Payment Amount | 164644.47 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 705 |
| Number Of Beneficiaries Age 65 to 74 | 2029 |
| Number Of Beneficiaries Age 75 to 84 | 1335 |
| Number Of Beneficiaries Age Greater 84 | 557 |
| Number Of Female Beneficiaries | 3482 |
| Number Of Male Beneficiaries | 1144 |
| Number Of Non Hispanic White Beneficiaries | 4441 |
| Number Of Black or African American Beneficiaries | 94 |
| Number Of AsianPacific Islander Beneficiaries | 27 |
| 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 | 3727 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 899 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.365 |