| National Provider Identifier [NPI]: | 1285636092 |
| Last Name Of The Provider | PACK |
| First Name Of The Provider | DAINA |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2002 MEDICAL PKWY |
| Street Address 2 Of The Provider | SUITE 235 |
| City Of The Provider | ANNAPOLIS |
| Zip Code Of The Provider | 214013046 |
| 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 | 159 |
| Number Of Services | 20372 |
| Number Of Medicare Beneficiaries | 4720 |
| Total Submitted Charge Amount | 1453209.9 |
| Total Medicare Allowed Amount | 619047.76 |
| Total Medicare Payment Amount | 512245.57 |
| Total Medicare Standardized Payment Amount | 480467.74 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 14016 |
| Number Of Medicare Beneficiaries With Drug Services | 219 |
| Total Drug Submitted ChargeAmount | 18060 |
| Total Drug Medicare AllowedAmount | 4184.76 |
| Total Drug Medicare PaymentAmount | 3052.35 |
| Total Drug Medicare Standardized Payment Amount | 3052.35 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 156 |
| Number Of Medical Services | 6356 |
| Number Of Medicare Beneficiaries With Medical Services | 4719 |
| Total Medical Submitted Charge Amount | 1435149.9 |
| Total Medical Medicare Allowed Amount | 614863 |
| Total Medical Medicare Payment Amount | 509193.22 |
| Total Medical Medicare Standardized Payment Amount | 477415.39 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 406 |
| Number Of Beneficiaries Age 65 to 74 | 2321 |
| Number Of Beneficiaries Age 75 to 84 | 1358 |
| Number Of Beneficiaries Age Greater 84 | 635 |
| Number Of Female Beneficiaries | 3458 |
| Number Of Male Beneficiaries | 1262 |
| Number Of Non Hispanic White Beneficiaries | 3864 |
| Number Of Black or African American Beneficiaries | 683 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 66 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 60 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4291 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 429 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.2543 |