| National Provider Identifier [NPI]: | 1326048380 |
| Last Name Of The Provider | MELLENCAMP |
| First Name Of The Provider | ERIC |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2501 KUSER RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | HAMILTON |
| Zip Code Of The Provider | 086913386 |
| State Code Of The Provider | NJ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 184 |
| Number Of Services | 6135 |
| Number Of Medicare Beneficiaries | 2787 |
| Total Submitted Charge Amount | 605269 |
| Total Medicare Allowed Amount | 149798.81 |
| Total Medicare Payment Amount | 121672.59 |
| Total Medicare Standardized Payment Amount | 121384.71 |
| 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 | 184 |
| Number Of Medical Services | 6135 |
| Number Of Medicare Beneficiaries With Medical Services | 2787 |
| Total Medical Submitted Charge Amount | 605269 |
| Total Medical Medicare Allowed Amount | 149798.81 |
| Total Medical Medicare Payment Amount | 121672.59 |
| Total Medical Medicare Standardized Payment Amount | 121384.71 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 729 |
| Number Of Beneficiaries Age 65 to 74 | 1020 |
| Number Of Beneficiaries Age 75 to 84 | 681 |
| Number Of Beneficiaries Age Greater 84 | 357 |
| Number Of Female Beneficiaries | 2016 |
| Number Of Male Beneficiaries | 771 |
| Number Of Non Hispanic White Beneficiaries | 1462 |
| Number Of Black or African American Beneficiaries | 1023 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 235 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 42 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1636 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1151 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.6745 |