| National Provider Identifier [NPI]: | 1194739375 |
| Last Name Of The Provider | PARK |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2002 MEDICAL PKWY |
| Street Address 2 Of The Provider | SUITE 235 |
| City Of The Provider | ANNAPOLIS |
| Zip Code Of The Provider | 214013046 |
| 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 | 183 |
| Number Of Services | 15547 |
| Number Of Medicare Beneficiaries | 3271 |
| Total Submitted Charge Amount | 1169510.3 |
| Total Medicare Allowed Amount | 399334.61 |
| Total Medicare Payment Amount | 305696.56 |
| Total Medicare Standardized Payment Amount | 291799.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 10858 |
| Number Of Medicare Beneficiaries With Drug Services | 181 |
| Total Drug Submitted ChargeAmount | 14450 |
| Total Drug Medicare AllowedAmount | 3902.31 |
| Total Drug Medicare PaymentAmount | 2911.63 |
| Total Drug Medicare Standardized Payment Amount | 2911.63 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 179 |
| Number Of Medical Services | 4689 |
| Number Of Medicare Beneficiaries With Medical Services | 3270 |
| Total Medical Submitted Charge Amount | 1155060.3 |
| Total Medical Medicare Allowed Amount | 395432.3 |
| Total Medical Medicare Payment Amount | 302784.93 |
| Total Medical Medicare Standardized Payment Amount | 288888.19 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 374 |
| Number Of Beneficiaries Age 65 to 74 | 1372 |
| Number Of Beneficiaries Age 75 to 84 | 986 |
| Number Of Beneficiaries Age Greater 84 | 539 |
| Number Of Female Beneficiaries | 1990 |
| Number Of Male Beneficiaries | 1281 |
| Number Of Non Hispanic White Beneficiaries | 2662 |
| Number Of Black or African American Beneficiaries | 511 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 38 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 35 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2909 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 362 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.5667 |