| National Provider Identifier [NPI]: | 1346208253 |
| Last Name Of The Provider | BISESI |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 429 S LANDMARK AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | BLOOMINGTON |
| Zip Code Of The Provider | 474035003 |
| 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 | 151 |
| Number Of Services | 24380 |
| Number Of Medicare Beneficiaries | 2059 |
| Total Submitted Charge Amount | 903516.49 |
| Total Medicare Allowed Amount | 216633.75 |
| Total Medicare Payment Amount | 163720.45 |
| Total Medicare Standardized Payment Amount | 175564.79 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 21602 |
| Number Of Medicare Beneficiaries With Drug Services | 214 |
| Total Drug Submitted ChargeAmount | 25249.49 |
| Total Drug Medicare AllowedAmount | 5253.79 |
| Total Drug Medicare PaymentAmount | 4094.98 |
| Total Drug Medicare Standardized Payment Amount | 4094.98 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 148 |
| Number Of Medical Services | 2778 |
| Number Of Medicare Beneficiaries With Medical Services | 2058 |
| Total Medical Submitted Charge Amount | 878267 |
| Total Medical Medicare Allowed Amount | 211379.96 |
| Total Medical Medicare Payment Amount | 159625.47 |
| Total Medical Medicare Standardized Payment Amount | 171469.81 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 420 |
| Number Of Beneficiaries Age 65 to 74 | 715 |
| Number Of Beneficiaries Age 75 to 84 | 653 |
| Number Of Beneficiaries Age Greater 84 | 271 |
| Number Of Female Beneficiaries | 1159 |
| Number Of Male Beneficiaries | 900 |
| Number Of Non Hispanic White Beneficiaries | 2011 |
| Number Of Black or African American Beneficiaries | 19 |
| 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 | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1491 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 568 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5153 |