| National Provider Identifier [NPI]: | 1871539155 |
| Last Name Of The Provider | BALSAM |
| First Name Of The Provider | DVORAH |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | UNIVERSITY HOSPITAL AT STONY BROOK |
| Street Address 2 Of The Provider | LEVEL 4 |
| City Of The Provider | STONY BROOK |
| Zip Code Of The Provider | 117940001 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 1649 |
| Number Of Medicare Beneficiaries | 1087 |
| Total Submitted Charge Amount | 78676 |
| Total Medicare Allowed Amount | 18524.05 |
| Total Medicare Payment Amount | 13627.3 |
| Total Medicare Standardized Payment Amount | 12081.57 |
| 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 | 46 |
| Number Of Medical Services | 1649 |
| Number Of Medicare Beneficiaries With Medical Services | 1087 |
| Total Medical Submitted Charge Amount | 78676 |
| Total Medical Medicare Allowed Amount | 18524.05 |
| Total Medical Medicare Payment Amount | 13627.3 |
| Total Medical Medicare Standardized Payment Amount | 12081.57 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 173 |
| Number Of Beneficiaries Age 65 to 74 | 340 |
| Number Of Beneficiaries Age 75 to 84 | 338 |
| Number Of Beneficiaries Age Greater 84 | 236 |
| Number Of Female Beneficiaries | 524 |
| Number Of Male Beneficiaries | 563 |
| Number Of Non Hispanic White Beneficiaries | 937 |
| Number Of Black or African American Beneficiaries | 57 |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| Number Of Hispanic Beneficiaries | 61 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 766 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 321 |
| Percent Of With Atrial Fibrillation | 33 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 57 |
| Percent Of With Chronic Kidney Disease | 55 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 20 |
| Average HCC Risk Score Of Beneficiaries | 2.3549 |