| National Provider Identifier [NPI]: | 1851390223 |
| Last Name Of The Provider | NIEDBALA |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 100 CARNIE BLVD |
| Street Address 2 Of The Provider | SUITE B-5 |
| City Of The Provider | VOORHEES |
| Zip Code Of The Provider | 080434512 |
| State Code Of The Provider | NJ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 144 |
| Number Of Services | 38919.6 |
| Number Of Medicare Beneficiaries | 2425 |
| Total Submitted Charge Amount | 2464875 |
| Total Medicare Allowed Amount | 519138.04 |
| Total Medicare Payment Amount | 397682.1 |
| Total Medicare Standardized Payment Amount | 367719.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 35883.6 |
| Number Of Medicare Beneficiaries With Drug Services | 494 |
| Total Drug Submitted ChargeAmount | 41864 |
| Total Drug Medicare AllowedAmount | 10531.81 |
| Total Drug Medicare PaymentAmount | 8256.79 |
| Total Drug Medicare Standardized Payment Amount | 8256.79 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 141 |
| Number Of Medical Services | 3036 |
| Number Of Medicare Beneficiaries With Medical Services | 2425 |
| Total Medical Submitted Charge Amount | 2423011 |
| Total Medical Medicare Allowed Amount | 508606.23 |
| Total Medical Medicare Payment Amount | 389425.31 |
| Total Medical Medicare Standardized Payment Amount | 359462.66 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 304 |
| Number Of Beneficiaries Age 65 to 74 | 976 |
| Number Of Beneficiaries Age 75 to 84 | 697 |
| Number Of Beneficiaries Age Greater 84 | 448 |
| Number Of Female Beneficiaries | 1408 |
| Number Of Male Beneficiaries | 1017 |
| Number Of Non Hispanic White Beneficiaries | 2050 |
| Number Of Black or African American Beneficiaries | 226 |
| Number Of AsianPacific Islander Beneficiaries | 43 |
| Number Of Hispanic Beneficiaries | 74 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 32 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2173 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 252 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.5915 |