| National Provider Identifier [NPI]: | 1235124710 |
| Last Name Of The Provider | MIRO |
| First Name Of The Provider | PEDRO |
| Middle Initial Of The Provider | A |
| 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 | 153 |
| Number Of Services | 5216 |
| Number Of Medicare Beneficiaries | 2621 |
| Total Submitted Charge Amount | 435528.89 |
| Total Medicare Allowed Amount | 162711.1 |
| Total Medicare Payment Amount | 120427.81 |
| Total Medicare Standardized Payment Amount | 128365.47 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 1647 |
| Number Of Medicare Beneficiaries With Drug Services | 114 |
| Total Drug Submitted ChargeAmount | 4232.7 |
| Total Drug Medicare AllowedAmount | 3888.08 |
| Total Drug Medicare PaymentAmount | 3025.26 |
| Total Drug Medicare Standardized Payment Amount | 3025.26 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 148 |
| Number Of Medical Services | 3569 |
| Number Of Medicare Beneficiaries With Medical Services | 2620 |
| Total Medical Submitted Charge Amount | 431296.19 |
| Total Medical Medicare Allowed Amount | 158823.02 |
| Total Medical Medicare Payment Amount | 117402.55 |
| Total Medical Medicare Standardized Payment Amount | 125340.21 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 584 |
| Number Of Beneficiaries Age 65 to 74 | 937 |
| Number Of Beneficiaries Age 75 to 84 | 690 |
| Number Of Beneficiaries Age Greater 84 | 410 |
| Number Of Female Beneficiaries | 1516 |
| Number Of Male Beneficiaries | 1105 |
| Number Of Non Hispanic White Beneficiaries | 2257 |
| Number Of Black or African American Beneficiaries | 281 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 54 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1855 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 766 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.6711 |