| National Provider Identifier [NPI]: | 1023003506 |
| Last Name Of The Provider | ORMSON |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 620 W EDISON RD |
| Street Address 2 Of The Provider | SUITE 110 |
| City Of The Provider | MISHAWAKA |
| Zip Code Of The Provider | 465452784 |
| 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 | 126 |
| Number Of Services | 4124 |
| Number Of Medicare Beneficiaries | 2802 |
| Total Submitted Charge Amount | 633802.19 |
| Total Medicare Allowed Amount | 123887.98 |
| Total Medicare Payment Amount | 87462.34 |
| Total Medicare Standardized Payment Amount | 92802.83 |
| 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 | 126 |
| Number Of Medical Services | 4124 |
| Number Of Medicare Beneficiaries With Medical Services | 2802 |
| Total Medical Submitted Charge Amount | 633802.19 |
| Total Medical Medicare Allowed Amount | 123887.98 |
| Total Medical Medicare Payment Amount | 87462.34 |
| Total Medical Medicare Standardized Payment Amount | 92802.83 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 603 |
| Number Of Beneficiaries Age 65 to 74 | 824 |
| Number Of Beneficiaries Age 75 to 84 | 775 |
| Number Of Beneficiaries Age Greater 84 | 600 |
| Number Of Female Beneficiaries | 1654 |
| Number Of Male Beneficiaries | 1148 |
| Number Of Non Hispanic White Beneficiaries | 2422 |
| Number Of Black or African American Beneficiaries | 269 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 60 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1903 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 899 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.7272 |