| National Provider Identifier [NPI]: | 1194710541 |
| Last Name Of The Provider | VANDERVEEN |
| First Name Of The Provider | KATRINA |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 620 W EDISON RD |
| Street Address 2 Of The Provider | SUITE 110 |
| City Of The Provider | MISHAWAKA |
| Zip Code Of The Provider | 465452784 |
| 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 | 170 |
| Number Of Services | 4835 |
| Number Of Medicare Beneficiaries | 2933 |
| Total Submitted Charge Amount | 593397.4 |
| Total Medicare Allowed Amount | 146079.24 |
| Total Medicare Payment Amount | 109916.66 |
| Total Medicare Standardized Payment Amount | 116407.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 668 |
| Number Of Medicare Beneficiaries With Drug Services | 45 |
| Total Drug Submitted ChargeAmount | 2126.12 |
| Total Drug Medicare AllowedAmount | 1714.22 |
| Total Drug Medicare PaymentAmount | 1222.33 |
| Total Drug Medicare Standardized Payment Amount | 1222.33 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 165 |
| Number Of Medical Services | 4167 |
| Number Of Medicare Beneficiaries With Medical Services | 2933 |
| Total Medical Submitted Charge Amount | 591271.28 |
| Total Medical Medicare Allowed Amount | 144365.02 |
| Total Medical Medicare Payment Amount | 108694.33 |
| Total Medical Medicare Standardized Payment Amount | 115184.83 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 553 |
| Number Of Beneficiaries Age 65 to 74 | 1058 |
| Number Of Beneficiaries Age 75 to 84 | 848 |
| Number Of Beneficiaries Age Greater 84 | 474 |
| Number Of Female Beneficiaries | 1813 |
| Number Of Male Beneficiaries | 1120 |
| Number Of Non Hispanic White Beneficiaries | 2579 |
| Number Of Black or African American Beneficiaries | 234 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 69 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2186 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 747 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.4318 |