| National Provider Identifier [NPI]: | 1801866397 |
| Last Name Of The Provider | BENNETT |
| First Name Of The Provider | ANTHONY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1899 ORCHARD LAKE RD |
| Street Address 2 Of The Provider | SUITE 104 |
| City Of The Provider | SYLVAN LAKE |
| Zip Code Of The Provider | 483201774 |
| 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 | 75 |
| Number Of Services | 2340 |
| Number Of Medicare Beneficiaries | 1545 |
| Total Submitted Charge Amount | 609880 |
| Total Medicare Allowed Amount | 288933.38 |
| Total Medicare Payment Amount | 219392.09 |
| Total Medicare Standardized Payment Amount | 218254.9 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 75 |
| Number Of Medicare Beneficiaries With Drug Services | 36 |
| Total Drug Submitted ChargeAmount | 1081 |
| Total Drug Medicare AllowedAmount | 61.64 |
| Total Drug Medicare PaymentAmount | 48.4 |
| Total Drug Medicare Standardized Payment Amount | 48.4 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 73 |
| Number Of Medical Services | 2265 |
| Number Of Medicare Beneficiaries With Medical Services | 1545 |
| Total Medical Submitted Charge Amount | 608799 |
| Total Medical Medicare Allowed Amount | 288871.74 |
| Total Medical Medicare Payment Amount | 219343.69 |
| Total Medical Medicare Standardized Payment Amount | 218206.5 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 224 |
| Number Of Beneficiaries Age 65 to 74 | 672 |
| Number Of Beneficiaries Age 75 to 84 | 473 |
| Number Of Beneficiaries Age Greater 84 | 176 |
| Number Of Female Beneficiaries | 925 |
| Number Of Male Beneficiaries | 620 |
| Number Of Non Hispanic White Beneficiaries | 1280 |
| Number Of Black or African American Beneficiaries | 173 |
| Number Of AsianPacific Islander Beneficiaries | 51 |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1332 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 213 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1703 |