| National Provider Identifier [NPI]: | 1053305680 |
| Last Name Of The Provider | KAMPLAIN |
| First Name Of The Provider | TREY |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8835 GERMANTOWN AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191182718 |
| 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 | 159 |
| Number Of Services | 6248 |
| Number Of Medicare Beneficiaries | 3598 |
| Total Submitted Charge Amount | 743872 |
| Total Medicare Allowed Amount | 180472.76 |
| Total Medicare Payment Amount | 135091.49 |
| Total Medicare Standardized Payment Amount | 130290.48 |
| 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 | 159 |
| Number Of Medical Services | 6248 |
| Number Of Medicare Beneficiaries With Medical Services | 3598 |
| Total Medical Submitted Charge Amount | 743872 |
| Total Medical Medicare Allowed Amount | 180472.76 |
| Total Medical Medicare Payment Amount | 135091.49 |
| Total Medical Medicare Standardized Payment Amount | 130290.48 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 554 |
| Number Of Beneficiaries Age 65 to 74 | 1343 |
| Number Of Beneficiaries Age 75 to 84 | 938 |
| Number Of Beneficiaries Age Greater 84 | 763 |
| Number Of Female Beneficiaries | 2359 |
| Number Of Male Beneficiaries | 1239 |
| Number Of Non Hispanic White Beneficiaries | 2120 |
| Number Of Black or African American Beneficiaries | 1315 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 86 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 46 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2675 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 923 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 25 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 1.7428 |