| National Provider Identifier [NPI]: | 1598747487 |
| Last Name Of The Provider | WELTIN |
| First Name Of The Provider | GREGORY |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 22 BRAMHALL ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PORTLAND |
| Zip Code Of The Provider | 041023134 |
| State Code Of The Provider | ME |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 133 |
| Number Of Services | 6859 |
| Number Of Medicare Beneficiaries | 4744 |
| Total Submitted Charge Amount | 882500 |
| Total Medicare Allowed Amount | 161938.12 |
| Total Medicare Payment Amount | 123343.92 |
| Total Medicare Standardized Payment Amount | 126983.67 |
| 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 | 133 |
| Number Of Medical Services | 6859 |
| Number Of Medicare Beneficiaries With Medical Services | 4744 |
| Total Medical Submitted Charge Amount | 882500 |
| Total Medical Medicare Allowed Amount | 161938.12 |
| Total Medical Medicare Payment Amount | 123343.92 |
| Total Medical Medicare Standardized Payment Amount | 126983.67 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 914 |
| Number Of Beneficiaries Age 65 to 74 | 1633 |
| Number Of Beneficiaries Age 75 to 84 | 1395 |
| Number Of Beneficiaries Age Greater 84 | 802 |
| Number Of Female Beneficiaries | 2898 |
| Number Of Male Beneficiaries | 1846 |
| Number Of Non Hispanic White Beneficiaries | 4598 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 33 |
| Number Of Hispanic Beneficiaries | 32 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 50 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2986 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1758 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.5313 |