| National Provider Identifier [NPI]: | 1437120102 |
| Last Name Of The Provider | BASEN |
| First Name Of The Provider | WALTER |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 20410 OBSERVATION DR |
| Street Address 2 Of The Provider | SUITE 104 |
| City Of The Provider | GERMANTOWN |
| Zip Code Of The Provider | 208764000 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 179 |
| Number Of Services | 9375 |
| Number Of Medicare Beneficiaries | 1775 |
| Total Submitted Charge Amount | 858562.6 |
| Total Medicare Allowed Amount | 367974.55 |
| Total Medicare Payment Amount | 298378.71 |
| Total Medicare Standardized Payment Amount | 260709.71 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 6205 |
| Number Of Medicare Beneficiaries With Drug Services | 100 |
| Total Drug Submitted ChargeAmount | 9800 |
| Total Drug Medicare AllowedAmount | 3484.29 |
| Total Drug Medicare PaymentAmount | 2731.66 |
| Total Drug Medicare Standardized Payment Amount | 2731.66 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 176 |
| Number Of Medical Services | 3170 |
| Number Of Medicare Beneficiaries With Medical Services | 1774 |
| Total Medical Submitted Charge Amount | 848762.6 |
| Total Medical Medicare Allowed Amount | 364490.26 |
| Total Medical Medicare Payment Amount | 295647.05 |
| Total Medical Medicare Standardized Payment Amount | 257978.05 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 204 |
| Number Of Beneficiaries Age 65 to 74 | 869 |
| Number Of Beneficiaries Age 75 to 84 | 508 |
| Number Of Beneficiaries Age Greater 84 | 194 |
| Number Of Female Beneficiaries | 1289 |
| Number Of Male Beneficiaries | 486 |
| Number Of Non Hispanic White Beneficiaries | 930 |
| Number Of Black or African American Beneficiaries | 247 |
| Number Of AsianPacific Islander Beneficiaries | 362 |
| Number Of Hispanic Beneficiaries | 172 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1194 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 581 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0931 |