| National Provider Identifier [NPI]: | 1588839526 |
| Last Name Of The Provider | DIDOLKAR |
| First Name Of The Provider | MANJIRI |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD, MS |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7253 AMBASSADOR RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BALTIMORE |
| Zip Code Of The Provider | 212442710 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 125 |
| Number Of Services | 7938 |
| Number Of Medicare Beneficiaries | 2190 |
| Total Submitted Charge Amount | 1845093.83 |
| Total Medicare Allowed Amount | 515345.13 |
| Total Medicare Payment Amount | 390230.48 |
| Total Medicare Standardized Payment Amount | 370022.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 5279 |
| Number Of Medicare Beneficiaries With Drug Services | 232 |
| Total Drug Submitted ChargeAmount | 10479.95 |
| Total Drug Medicare AllowedAmount | 7161.28 |
| Total Drug Medicare PaymentAmount | 5252.49 |
| Total Drug Medicare Standardized Payment Amount | 5252.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 121 |
| Number Of Medical Services | 2659 |
| Number Of Medicare Beneficiaries With Medical Services | 2189 |
| Total Medical Submitted Charge Amount | 1834613.88 |
| Total Medical Medicare Allowed Amount | 508183.85 |
| Total Medical Medicare Payment Amount | 384977.99 |
| Total Medical Medicare Standardized Payment Amount | 364769.67 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 368 |
| Number Of Beneficiaries Age 65 to 74 | 923 |
| Number Of Beneficiaries Age 75 to 84 | 629 |
| Number Of Beneficiaries Age Greater 84 | 270 |
| Number Of Female Beneficiaries | 1363 |
| Number Of Male Beneficiaries | 827 |
| Number Of Non Hispanic White Beneficiaries | 1781 |
| Number Of Black or African American Beneficiaries | 329 |
| Number Of AsianPacific Islander Beneficiaries | 38 |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 26 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1867 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 323 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 62 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.4204 |