| National Provider Identifier [NPI]: | 1043339310 |
| Last Name Of The Provider | STASER |
| First Name Of The Provider | JONATHAN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 429 S LANDMARK AVENUE |
| Street Address 2 Of The Provider | |
| City Of The Provider | BLOOMINGTON |
| Zip Code Of The Provider | 474035003 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 183 |
| Number Of Services | 8644 |
| Number Of Medicare Beneficiaries | 3954 |
| Total Submitted Charge Amount | 719095.05 |
| Total Medicare Allowed Amount | 199503.29 |
| Total Medicare Payment Amount | 149103.87 |
| Total Medicare Standardized Payment Amount | 157787.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 2596 |
| Number Of Medicare Beneficiaries With Drug Services | 50 |
| Total Drug Submitted ChargeAmount | 5280.05 |
| Total Drug Medicare AllowedAmount | 1817.89 |
| Total Drug Medicare PaymentAmount | 1425.2 |
| Total Drug Medicare Standardized Payment Amount | 1425.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 179 |
| Number Of Medical Services | 6048 |
| Number Of Medicare Beneficiaries With Medical Services | 3954 |
| Total Medical Submitted Charge Amount | 713815 |
| Total Medical Medicare Allowed Amount | 197685.4 |
| Total Medical Medicare Payment Amount | 147678.67 |
| Total Medical Medicare Standardized Payment Amount | 156362.47 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 759 |
| Number Of Beneficiaries Age 65 to 74 | 1432 |
| Number Of Beneficiaries Age 75 to 84 | 1117 |
| Number Of Beneficiaries Age Greater 84 | 646 |
| Number Of Female Beneficiaries | 2300 |
| Number Of Male Beneficiaries | 1654 |
| Number Of Non Hispanic White Beneficiaries | 3822 |
| Number Of Black or African American Beneficiaries | 55 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 37 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2903 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1051 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4685 |