| National Provider Identifier [NPI]: | 1619976230 |
| Last Name Of The Provider | VRDOLJAK |
| First Name Of The Provider | JAKE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8926 WOODYARD RD |
| Street Address 2 Of The Provider | SUITE 301 |
| City Of The Provider | CLINTON |
| Zip Code Of The Provider | 20735 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 167 |
| Number Of Services | 12318 |
| Number Of Medicare Beneficiaries | 1641 |
| Total Submitted Charge Amount | 1160015.38 |
| Total Medicare Allowed Amount | 370340.15 |
| Total Medicare Payment Amount | 284308.1 |
| Total Medicare Standardized Payment Amount | 277228.6 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 9798 |
| Number Of Medicare Beneficiaries With Drug Services | 129 |
| Total Drug Submitted ChargeAmount | 5339.32 |
| Total Drug Medicare AllowedAmount | 3180.08 |
| Total Drug Medicare PaymentAmount | 2469.06 |
| Total Drug Medicare Standardized Payment Amount | 2469.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 164 |
| Number Of Medical Services | 2520 |
| Number Of Medicare Beneficiaries With Medical Services | 1641 |
| Total Medical Submitted Charge Amount | 1154676.06 |
| Total Medical Medicare Allowed Amount | 367160.07 |
| Total Medical Medicare Payment Amount | 281839.04 |
| Total Medical Medicare Standardized Payment Amount | 274759.54 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 171 |
| Number Of Beneficiaries Age 65 to 74 | 905 |
| Number Of Beneficiaries Age 75 to 84 | 456 |
| Number Of Beneficiaries Age Greater 84 | 109 |
| Number Of Female Beneficiaries | 1198 |
| Number Of Male Beneficiaries | 443 |
| Number Of Non Hispanic White Beneficiaries | 944 |
| Number Of Black or African American Beneficiaries | 568 |
| Number Of AsianPacific Islander Beneficiaries | 48 |
| Number Of Hispanic Beneficiaries | 48 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 33 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1450 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 191 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0836 |