| National Provider Identifier [NPI]: | 1255377016 |
| Last Name Of The Provider | OTTMAR |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1234 NAPIER AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | ST JOSEPH |
| Zip Code Of The Provider | 49085 |
| 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 | 121 |
| Number Of Services | 6148 |
| Number Of Medicare Beneficiaries | 3467 |
| Total Submitted Charge Amount | 410233 |
| Total Medicare Allowed Amount | 137437.14 |
| Total Medicare Payment Amount | 114018.26 |
| Total Medicare Standardized Payment Amount | 117419.4 |
| 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 | 121 |
| Number Of Medical Services | 6148 |
| Number Of Medicare Beneficiaries With Medical Services | 3467 |
| Total Medical Submitted Charge Amount | 410233 |
| Total Medical Medicare Allowed Amount | 137437.14 |
| Total Medical Medicare Payment Amount | 114018.26 |
| Total Medical Medicare Standardized Payment Amount | 117419.4 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 612 |
| Number Of Beneficiaries Age 65 to 74 | 1392 |
| Number Of Beneficiaries Age 75 to 84 | 1039 |
| Number Of Beneficiaries Age Greater 84 | 424 |
| Number Of Female Beneficiaries | 2798 |
| Number Of Male Beneficiaries | 669 |
| Number Of Non Hispanic White Beneficiaries | 2794 |
| Number Of Black or African American Beneficiaries | 598 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 31 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2585 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 882 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.3311 |