| National Provider Identifier [NPI]: | 1659404325 |
| Last Name Of The Provider | PHAM |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 401 SW WATER ST |
| Street Address 2 Of The Provider | SUITE 507 |
| City Of The Provider | PEORIA |
| Zip Code Of The Provider | 616021571 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 100 |
| Number Of Services | 2715 |
| Number Of Medicare Beneficiaries | 2088 |
| Total Submitted Charge Amount | 374383 |
| Total Medicare Allowed Amount | 64708.02 |
| Total Medicare Payment Amount | 47251.69 |
| Total Medicare Standardized Payment Amount | 48182.1 |
| 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 | 100 |
| Number Of Medical Services | 2715 |
| Number Of Medicare Beneficiaries With Medical Services | 2088 |
| Total Medical Submitted Charge Amount | 374383 |
| Total Medical Medicare Allowed Amount | 64708.02 |
| Total Medical Medicare Payment Amount | 47251.69 |
| Total Medical Medicare Standardized Payment Amount | 48182.1 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 396 |
| Number Of Beneficiaries Age 65 to 74 | 731 |
| Number Of Beneficiaries Age 75 to 84 | 628 |
| Number Of Beneficiaries Age Greater 84 | 333 |
| Number Of Female Beneficiaries | 1123 |
| Number Of Male Beneficiaries | 965 |
| Number Of Non Hispanic White Beneficiaries | 1937 |
| Number Of Black or African American Beneficiaries | 94 |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1583 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 505 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.7318 |