| National Provider Identifier [NPI]: | 1639330533 |
| Last Name Of The Provider | VAN |
| First Name Of The Provider | PHILLIP |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D., M.S. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 601 N CAROLINE ST |
| Street Address 2 Of The Provider | JHOC 3235A |
| City Of The Provider | BALTIMORE |
| Zip Code Of The Provider | 212870006 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 97 |
| Number Of Services | 1587 |
| Number Of Medicare Beneficiaries | 1205 |
| Total Submitted Charge Amount | 278377 |
| Total Medicare Allowed Amount | 60007.93 |
| Total Medicare Payment Amount | 45655.38 |
| Total Medicare Standardized Payment Amount | 43911.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 17 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 2397 |
| Total Drug Medicare AllowedAmount | 4.07 |
| Total Drug Medicare PaymentAmount | 3.24 |
| Total Drug Medicare Standardized Payment Amount | 3.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 95 |
| Number Of Medical Services | 1570 |
| Number Of Medicare Beneficiaries With Medical Services | 1205 |
| Total Medical Submitted Charge Amount | 275980 |
| Total Medical Medicare Allowed Amount | 60003.86 |
| Total Medical Medicare Payment Amount | 45652.14 |
| Total Medical Medicare Standardized Payment Amount | 43908.69 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 316 |
| Number Of Beneficiaries Age 65 to 74 | 468 |
| Number Of Beneficiaries Age 75 to 84 | 300 |
| Number Of Beneficiaries Age Greater 84 | 121 |
| Number Of Female Beneficiaries | 661 |
| Number Of Male Beneficiaries | 544 |
| Number Of Non Hispanic White Beneficiaries | 822 |
| Number Of Black or African American Beneficiaries | 319 |
| Number Of AsianPacific Islander Beneficiaries | 26 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 864 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 341 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 59 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.0579 |