| National Provider Identifier [NPI]: | 1629001185 |
| Last Name Of The Provider | CHESNUT |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3264 N EVERGREEN DR NE |
| Street Address 2 Of The Provider | |
| City Of The Provider | GRAND RAPIDS |
| Zip Code Of The Provider | 495259746 |
| 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 | 157 |
| Number Of Services | 4850 |
| Number Of Medicare Beneficiaries | 3306 |
| Total Submitted Charge Amount | 427710 |
| Total Medicare Allowed Amount | 116334.89 |
| Total Medicare Payment Amount | 89205.96 |
| Total Medicare Standardized Payment Amount | 91774.09 |
| 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 | 157 |
| Number Of Medical Services | 4850 |
| Number Of Medicare Beneficiaries With Medical Services | 3306 |
| Total Medical Submitted Charge Amount | 427710 |
| Total Medical Medicare Allowed Amount | 116334.89 |
| Total Medical Medicare Payment Amount | 89205.96 |
| Total Medical Medicare Standardized Payment Amount | 91774.09 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 760 |
| Number Of Beneficiaries Age 65 to 74 | 1102 |
| Number Of Beneficiaries Age 75 to 84 | 889 |
| Number Of Beneficiaries Age Greater 84 | 555 |
| Number Of Female Beneficiaries | 1984 |
| Number Of Male Beneficiaries | 1322 |
| Number Of Non Hispanic White Beneficiaries | 2924 |
| Number Of Black or African American Beneficiaries | 226 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 89 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 38 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2288 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1018 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.8567 |