| National Provider Identifier [NPI]: | 1467697870 |
| Last Name Of The Provider | SAMOILOV |
| First Name Of The Provider | DMITRI |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5544 GREENWICH RD STE 200 |
| Street Address 2 Of The Provider | |
| City Of The Provider | VIRGINIA BEACH |
| Zip Code Of The Provider | 234626563 |
| 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 | 214 |
| Number Of Services | 3310 |
| Number Of Medicare Beneficiaries | 1677 |
| Total Submitted Charge Amount | 746474.99 |
| Total Medicare Allowed Amount | 195514.29 |
| Total Medicare Payment Amount | 149598.6 |
| Total Medicare Standardized Payment Amount | 153811.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 214 |
| Number Of Medical Services | 3310 |
| Number Of Medicare Beneficiaries With Medical Services | 1677 |
| Total Medical Submitted Charge Amount | 746474.99 |
| Total Medical Medicare Allowed Amount | 195514.29 |
| Total Medical Medicare Payment Amount | 149598.6 |
| Total Medical Medicare Standardized Payment Amount | 153811.62 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 352 |
| Number Of Beneficiaries Age 65 to 74 | 605 |
| Number Of Beneficiaries Age 75 to 84 | 472 |
| Number Of Beneficiaries Age Greater 84 | 248 |
| Number Of Female Beneficiaries | 950 |
| Number Of Male Beneficiaries | 727 |
| Number Of Non Hispanic White Beneficiaries | 983 |
| Number Of Black or African American Beneficiaries | 632 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 26 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1309 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 368 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.0998 |