| National Provider Identifier [NPI]: | 1760469563 |
| Last Name Of The Provider | HALLENBECK |
| First Name Of The Provider | JONATHAN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 149 NORTH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | WATERVILLE |
| Zip Code Of The Provider | 049014974 |
| 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 | 180 |
| Number Of Services | 6964 |
| Number Of Medicare Beneficiaries | 3987 |
| Total Submitted Charge Amount | 762156 |
| Total Medicare Allowed Amount | 177902.69 |
| Total Medicare Payment Amount | 137921.35 |
| Total Medicare Standardized Payment Amount | 145012.4 |
| 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 | 180 |
| Number Of Medical Services | 6964 |
| Number Of Medicare Beneficiaries With Medical Services | 3987 |
| Total Medical Submitted Charge Amount | 762156 |
| Total Medical Medicare Allowed Amount | 177902.69 |
| Total Medical Medicare Payment Amount | 137921.35 |
| Total Medical Medicare Standardized Payment Amount | 145012.4 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 1173 |
| Number Of Beneficiaries Age 65 to 74 | 1303 |
| Number Of Beneficiaries Age 75 to 84 | 989 |
| Number Of Beneficiaries Age Greater 84 | 522 |
| Number Of Female Beneficiaries | 2642 |
| Number Of Male Beneficiaries | 1345 |
| Number Of Non Hispanic White Beneficiaries | 3910 |
| Number Of Black or African American Beneficiaries | 13 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 33 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1891 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 2096 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3888 |