| National Provider Identifier [NPI]: | 1619945342 |
| Last Name Of The Provider | BENANTI |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1000 MONTAUK HIGHWAY |
| Street Address 2 Of The Provider | GOOD SAMARITAN HOSPITAL |
| City Of The Provider | WEST ISLIP |
| Zip Code Of The Provider | 11795 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 169 |
| Number Of Services | 7361 |
| Number Of Medicare Beneficiaries | 4244 |
| Total Submitted Charge Amount | 953220 |
| Total Medicare Allowed Amount | 267087.41 |
| Total Medicare Payment Amount | 204712.08 |
| Total Medicare Standardized Payment Amount | 186313.54 |
| 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 | 169 |
| Number Of Medical Services | 7361 |
| Number Of Medicare Beneficiaries With Medical Services | 4244 |
| Total Medical Submitted Charge Amount | 953220 |
| Total Medical Medicare Allowed Amount | 267087.41 |
| Total Medical Medicare Payment Amount | 204712.08 |
| Total Medical Medicare Standardized Payment Amount | 186313.54 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 693 |
| Number Of Beneficiaries Age 65 to 74 | 1135 |
| Number Of Beneficiaries Age 75 to 84 | 1333 |
| Number Of Beneficiaries Age Greater 84 | 1083 |
| Number Of Female Beneficiaries | 2441 |
| Number Of Male Beneficiaries | 1803 |
| Number Of Non Hispanic White Beneficiaries | 3616 |
| Number Of Black or African American Beneficiaries | 301 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 215 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 65 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2981 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1263 |
| Percent Of With Atrial Fibrillation | 27 |
| Percent Of With Alzheimers Disease or Dementia | 30 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 65 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 19 |
| Average HCC Risk Score Of Beneficiaries | 2.0928 |