| National Provider Identifier [NPI]: | 1104844125 |
| Last Name Of The Provider | LADER |
| First Name Of The Provider | CLIFFORD |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2722 MERRILEE DR |
| Street Address 2 Of The Provider | SUITE 230 |
| City Of The Provider | FAIRFAX |
| Zip Code Of The Provider | 220314400 |
| 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 | 42 |
| Number Of Services | 10026 |
| Number Of Medicare Beneficiaries | 1294 |
| Total Submitted Charge Amount | 1014120.3 |
| Total Medicare Allowed Amount | 198794.53 |
| Total Medicare Payment Amount | 147653.85 |
| Total Medicare Standardized Payment Amount | 135519.32 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 8310 |
| Number Of Medicare Beneficiaries With Drug Services | 93 |
| Total Drug Submitted ChargeAmount | 8624.3 |
| Total Drug Medicare AllowedAmount | 2323.43 |
| Total Drug Medicare PaymentAmount | 1599.13 |
| Total Drug Medicare Standardized Payment Amount | 1599.13 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 1716 |
| Number Of Medicare Beneficiaries With Medical Services | 1294 |
| Total Medical Submitted Charge Amount | 1005496 |
| Total Medical Medicare Allowed Amount | 196471.1 |
| Total Medical Medicare Payment Amount | 146054.72 |
| Total Medical Medicare Standardized Payment Amount | 133920.19 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 102 |
| Number Of Beneficiaries Age 65 to 74 | 512 |
| Number Of Beneficiaries Age 75 to 84 | 428 |
| Number Of Beneficiaries Age Greater 84 | 252 |
| Number Of Female Beneficiaries | 707 |
| Number Of Male Beneficiaries | 587 |
| Number Of Non Hispanic White Beneficiaries | 956 |
| Number Of Black or African American Beneficiaries | 79 |
| Number Of AsianPacific Islander Beneficiaries | 161 |
| Number Of Hispanic Beneficiaries | 53 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1074 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 220 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 25 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 23 |
| Average HCC Risk Score Of Beneficiaries | 1.46 |