| National Provider Identifier [NPI]: | 1396765053 |
| Last Name Of The Provider | LEWIS |
| First Name Of The Provider | VAN |
| 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 | 1970 ROANOKE BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SALEM |
| Zip Code Of The Provider | 241536404 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 242 |
| Number Of Services | 29277 |
| Number Of Medicare Beneficiaries | 2632 |
| Total Submitted Charge Amount | 1591335.91 |
| Total Medicare Allowed Amount | 818385.15 |
| Total Medicare Payment Amount | 630386.61 |
| Total Medicare Standardized Payment Amount | 625739.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 24411 |
| Number Of Medicare Beneficiaries With Drug Services | 259 |
| Total Drug Submitted ChargeAmount | 28848 |
| Total Drug Medicare AllowedAmount | 6154.3 |
| Total Drug Medicare PaymentAmount | 4740.67 |
| Total Drug Medicare Standardized Payment Amount | 4740.67 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 238 |
| Number Of Medical Services | 4866 |
| Number Of Medicare Beneficiaries With Medical Services | 2632 |
| Total Medical Submitted Charge Amount | 1562487.91 |
| Total Medical Medicare Allowed Amount | 812230.85 |
| Total Medical Medicare Payment Amount | 625645.94 |
| Total Medical Medicare Standardized Payment Amount | 620999.15 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 414 |
| Number Of Beneficiaries Age 65 to 74 | 892 |
| Number Of Beneficiaries Age 75 to 84 | 821 |
| Number Of Beneficiaries Age Greater 84 | 505 |
| Number Of Female Beneficiaries | 1547 |
| Number Of Male Beneficiaries | 1085 |
| Number Of Non Hispanic White Beneficiaries | 2373 |
| Number Of Black or African American Beneficiaries | 223 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2117 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 515 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.6961 |