| National Provider Identifier [NPI]: | 1518171107 |
| Last Name Of The Provider | GREENE |
| First Name Of The Provider | RYAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 121 S SAINT LOUIS BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SOUTH BEND |
| Zip Code Of The Provider | 466172924 |
| 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 | 180 |
| Number Of Services | 1644 |
| Number Of Medicare Beneficiaries | 749 |
| Total Submitted Charge Amount | 709912.01 |
| Total Medicare Allowed Amount | 152501.26 |
| Total Medicare Payment Amount | 116787.75 |
| Total Medicare Standardized Payment Amount | 123613.26 |
| Drug Suppress Indicator | * |
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| Number Of Drug Services | |
| Number Of Medicare Beneficiaries With Drug Services | |
| Total Drug Submitted ChargeAmount | |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
| Total Medical Submitted Charge Amount | |
| Total Medical Medicare Allowed Amount | |
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| Total Medical Medicare Standardized Payment Amount | |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 171 |
| Number Of Beneficiaries Age 65 to 74 | 262 |
| Number Of Beneficiaries Age 75 to 84 | 205 |
| Number Of Beneficiaries Age Greater 84 | 111 |
| Number Of Female Beneficiaries | 407 |
| Number Of Male Beneficiaries | 342 |
| Number Of Non Hispanic White Beneficiaries | 668 |
| Number Of Black or African American Beneficiaries | 53 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 531 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 218 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.2763 |