| National Provider Identifier [NPI]: | 1659397867 |
| Last Name Of The Provider | CUNNINGHAM |
| First Name Of The Provider | THEODORE |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3264 N EVERGREEN DR NE |
| Street Address 2 Of The Provider | |
| City Of The Provider | GRAND RAPIDS |
| Zip Code Of The Provider | 495259746 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 144 |
| Number Of Services | 7811 |
| Number Of Medicare Beneficiaries | 2467 |
| Total Submitted Charge Amount | 603730 |
| Total Medicare Allowed Amount | 122080.1 |
| Total Medicare Payment Amount | 91801.92 |
| Total Medicare Standardized Payment Amount | 95683.36 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 4255 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 9601 |
| Total Drug Medicare AllowedAmount | 910.99 |
| Total Drug Medicare PaymentAmount | 697.85 |
| Total Drug Medicare Standardized Payment Amount | 697.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 142 |
| Number Of Medical Services | 3556 |
| Number Of Medicare Beneficiaries With Medical Services | 2467 |
| Total Medical Submitted Charge Amount | 594129 |
| Total Medical Medicare Allowed Amount | 121169.11 |
| Total Medical Medicare Payment Amount | 91104.07 |
| Total Medical Medicare Standardized Payment Amount | 94985.51 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 615 |
| Number Of Beneficiaries Age 65 to 74 | 769 |
| Number Of Beneficiaries Age 75 to 84 | 676 |
| Number Of Beneficiaries Age Greater 84 | 407 |
| Number Of Female Beneficiaries | 1446 |
| Number Of Male Beneficiaries | 1021 |
| Number Of Non Hispanic White Beneficiaries | 2151 |
| Number Of Black or African American Beneficiaries | 223 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 51 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1719 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 748 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.7335 |