| National Provider Identifier [NPI]: | 1497778732 |
| Last Name Of The Provider | SPACE |
| First Name Of The Provider | TODD |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10850 E TRAVERSE HWY |
| Street Address 2 Of The Provider | SUITE 60 |
| City Of The Provider | TRAVERSE CITY |
| Zip Code Of The Provider | 496841364 |
| 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 | 191 |
| Number Of Services | 4864 |
| Number Of Medicare Beneficiaries | 3419 |
| Total Submitted Charge Amount | 378675 |
| Total Medicare Allowed Amount | 133536.91 |
| Total Medicare Payment Amount | 102139.33 |
| Total Medicare Standardized Payment Amount | 105315.43 |
| 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 | 191 |
| Number Of Medical Services | 4864 |
| Number Of Medicare Beneficiaries With Medical Services | 3419 |
| Total Medical Submitted Charge Amount | 378675 |
| Total Medical Medicare Allowed Amount | 133536.91 |
| Total Medical Medicare Payment Amount | 102139.33 |
| Total Medical Medicare Standardized Payment Amount | 105315.43 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 660 |
| Number Of Beneficiaries Age 65 to 74 | 1180 |
| Number Of Beneficiaries Age 75 to 84 | 1080 |
| Number Of Beneficiaries Age Greater 84 | 499 |
| Number Of Female Beneficiaries | 1965 |
| Number Of Male Beneficiaries | 1454 |
| Number Of Non Hispanic White Beneficiaries | 3310 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | 40 |
| Number Of Beneficiaries With Race Not Else where Classified | 30 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2524 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 895 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5082 |