| National Provider Identifier [NPI]: | 1740251271 |
| Last Name Of The Provider | BORTNICK |
| First Name Of The Provider | BRUCE |
| Middle Initial Of The Provider | J |
| 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 | 151 |
| Number Of Services | 11134 |
| Number Of Medicare Beneficiaries | 2915 |
| Total Submitted Charge Amount | 758029 |
| Total Medicare Allowed Amount | 250084.98 |
| Total Medicare Payment Amount | 199245.93 |
| Total Medicare Standardized Payment Amount | 175643.65 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 6407 |
| Number Of Medicare Beneficiaries With Drug Services | 58 |
| Total Drug Submitted ChargeAmount | 7317 |
| Total Drug Medicare AllowedAmount | 1794.94 |
| Total Drug Medicare PaymentAmount | 1407.06 |
| Total Drug Medicare Standardized Payment Amount | 1407.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 149 |
| Number Of Medical Services | 4727 |
| Number Of Medicare Beneficiaries With Medical Services | 2915 |
| Total Medical Submitted Charge Amount | 750712 |
| Total Medical Medicare Allowed Amount | 248290.04 |
| Total Medical Medicare Payment Amount | 197838.87 |
| Total Medical Medicare Standardized Payment Amount | 174236.59 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 343 |
| Number Of Beneficiaries Age 65 to 74 | 1009 |
| Number Of Beneficiaries Age 75 to 84 | 940 |
| Number Of Beneficiaries Age Greater 84 | 623 |
| Number Of Female Beneficiaries | 1841 |
| Number Of Male Beneficiaries | 1074 |
| Number Of Non Hispanic White Beneficiaries | 1770 |
| Number Of Black or African American Beneficiaries | 393 |
| Number Of AsianPacific Islander Beneficiaries | 449 |
| Number Of Hispanic Beneficiaries | 232 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 71 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1951 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 964 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.6295 |