| National Provider Identifier [NPI]: | 1891992574 |
| Last Name Of The Provider | VANCE |
| First Name Of The Provider | LAURIE |
| 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 | HENRY FORD HOSPITAL- 2799 W. GRAND BOULEVARD |
| Street Address 2 Of The Provider | |
| City Of The Provider | DETROIT |
| Zip Code Of The Provider | 482022608 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 220 |
| Number Of Services | 2994 |
| Number Of Medicare Beneficiaries | 1788 |
| Total Submitted Charge Amount | 265135.1 |
| Total Medicare Allowed Amount | 100084.61 |
| Total Medicare Payment Amount | 78299.53 |
| Total Medicare Standardized Payment Amount | 75271.01 |
| 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 | 220 |
| Number Of Medical Services | 2994 |
| Number Of Medicare Beneficiaries With Medical Services | 1788 |
| Total Medical Submitted Charge Amount | 265135.1 |
| Total Medical Medicare Allowed Amount | 100084.61 |
| Total Medical Medicare Payment Amount | 78299.53 |
| Total Medical Medicare Standardized Payment Amount | 75271.01 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 374 |
| Number Of Beneficiaries Age 65 to 74 | 618 |
| Number Of Beneficiaries Age 75 to 84 | 457 |
| Number Of Beneficiaries Age Greater 84 | 339 |
| Number Of Female Beneficiaries | 1239 |
| Number Of Male Beneficiaries | 549 |
| Number Of Non Hispanic White Beneficiaries | 947 |
| Number Of Black or African American Beneficiaries | 796 |
| Number Of AsianPacific Islander Beneficiaries | 13 |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1258 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 530 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.0679 |