| National Provider Identifier [NPI]: | 1124013677 |
| Last Name Of The Provider | DYNES |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| 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 | 167 |
| Number Of Services | 4731 |
| Number Of Medicare Beneficiaries | 2724 |
| Total Submitted Charge Amount | 634177.66 |
| Total Medicare Allowed Amount | 161566.5 |
| Total Medicare Payment Amount | 118501.7 |
| Total Medicare Standardized Payment Amount | 125505.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 941 |
| Number Of Medicare Beneficiaries With Drug Services | 64 |
| Total Drug Submitted ChargeAmount | 2264.26 |
| Total Drug Medicare AllowedAmount | 2015.48 |
| Total Drug Medicare PaymentAmount | 1569.04 |
| Total Drug Medicare Standardized Payment Amount | 1569.04 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 163 |
| Number Of Medical Services | 3790 |
| Number Of Medicare Beneficiaries With Medical Services | 2723 |
| Total Medical Submitted Charge Amount | 631913.4 |
| Total Medical Medicare Allowed Amount | 159551.02 |
| Total Medical Medicare Payment Amount | 116932.66 |
| Total Medical Medicare Standardized Payment Amount | 123936.74 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 566 |
| Number Of Beneficiaries Age 65 to 74 | 895 |
| Number Of Beneficiaries Age 75 to 84 | 742 |
| Number Of Beneficiaries Age Greater 84 | 521 |
| Number Of Female Beneficiaries | 1591 |
| Number Of Male Beneficiaries | 1133 |
| Number Of Non Hispanic White Beneficiaries | 2414 |
| Number Of Black or African American Beneficiaries | 216 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 58 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 23 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1932 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 792 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 58 |
| 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 | 8 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.5947 |