| National Provider Identifier [NPI]: | 1932192812 |
| Last Name Of The Provider | WOLDENBERG |
| First Name Of The Provider | LEE |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3000 ARLINGTON AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | TOLEDO |
| Zip Code Of The Provider | 436142595 |
| 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 | 115 |
| Number Of Services | 3187 |
| Number Of Medicare Beneficiaries | 1774 |
| Total Submitted Charge Amount | 142597.52 |
| Total Medicare Allowed Amount | 54824.45 |
| Total Medicare Payment Amount | 42004.85 |
| Total Medicare Standardized Payment Amount | 43021.21 |
| 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 | 115 |
| Number Of Medical Services | 3187 |
| Number Of Medicare Beneficiaries With Medical Services | 1774 |
| Total Medical Submitted Charge Amount | 142597.52 |
| Total Medical Medicare Allowed Amount | 54824.45 |
| Total Medical Medicare Payment Amount | 42004.85 |
| Total Medical Medicare Standardized Payment Amount | 43021.21 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 641 |
| Number Of Beneficiaries Age 65 to 74 | 584 |
| Number Of Beneficiaries Age 75 to 84 | 365 |
| Number Of Beneficiaries Age Greater 84 | 184 |
| Number Of Female Beneficiaries | 1043 |
| Number Of Male Beneficiaries | 731 |
| Number Of Non Hispanic White Beneficiaries | 1284 |
| Number Of Black or African American Beneficiaries | 394 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 61 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 23 |
| Number Of Beneficiaries With Medicare Only Entitlement | 976 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 798 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.2251 |