| National Provider Identifier [NPI]: | 1770518367 |
| Last Name Of The Provider | MALLY |
| First Name Of The Provider | GARY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 605 W WESTERN AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MUSKEGON |
| Zip Code Of The Provider | 494401080 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 167 |
| Number Of Services | 4581 |
| Number Of Medicare Beneficiaries | 3423 |
| Total Submitted Charge Amount | 508114.4 |
| Total Medicare Allowed Amount | 129261.97 |
| Total Medicare Payment Amount | 100247.08 |
| Total Medicare Standardized Payment Amount | 103618.97 |
| 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 | 167 |
| Number Of Medical Services | 4581 |
| Number Of Medicare Beneficiaries With Medical Services | 3423 |
| Total Medical Submitted Charge Amount | 508114.4 |
| Total Medical Medicare Allowed Amount | 129261.97 |
| Total Medical Medicare Payment Amount | 100247.08 |
| Total Medical Medicare Standardized Payment Amount | 103618.97 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 968 |
| Number Of Beneficiaries Age 65 to 74 | 1056 |
| Number Of Beneficiaries Age 75 to 84 | 873 |
| Number Of Beneficiaries Age Greater 84 | 526 |
| Number Of Female Beneficiaries | 1936 |
| Number Of Male Beneficiaries | 1487 |
| Number Of Non Hispanic White Beneficiaries | 2844 |
| Number Of Black or African American Beneficiaries | 433 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 90 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2222 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1201 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6288 |