| National Provider Identifier [NPI]: | 1902088438 |
| Last Name Of The Provider | DITTMAR |
| First Name Of The Provider | KRISTIN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 395 W 12TH AVE |
| Street Address 2 Of The Provider | 4TH FLOOR |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 432101267 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 64 |
| Number Of Services | 1434 |
| Number Of Medicare Beneficiaries | 975 |
| Total Submitted Charge Amount | 295552 |
| Total Medicare Allowed Amount | 83339.51 |
| Total Medicare Payment Amount | 63881.28 |
| Total Medicare Standardized Payment Amount | 65756.43 |
| 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 | 64 |
| Number Of Medical Services | 1434 |
| Number Of Medicare Beneficiaries With Medical Services | 975 |
| Total Medical Submitted Charge Amount | 295552 |
| Total Medical Medicare Allowed Amount | 83339.51 |
| Total Medical Medicare Payment Amount | 63881.28 |
| Total Medical Medicare Standardized Payment Amount | 65756.43 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 394 |
| Number Of Beneficiaries Age 65 to 74 | 352 |
| Number Of Beneficiaries Age 75 to 84 | 180 |
| Number Of Beneficiaries Age Greater 84 | 49 |
| Number Of Female Beneficiaries | 458 |
| Number Of Male Beneficiaries | 517 |
| Number Of Non Hispanic White Beneficiaries | 747 |
| Number Of Black or African American Beneficiaries | 197 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 573 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 402 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 60 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.6372 |