| National Provider Identifier [NPI]: | 1053583401 |
| Last Name Of The Provider | LEWIS |
| First Name Of The Provider | JON |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 328 E 73RD ST |
| Street Address 2 Of The Provider | APARTMENT 4C |
| City Of The Provider | NEW YORK |
| Zip Code Of The Provider | 100214442 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 203 |
| Number Of Services | 21750 |
| Number Of Medicare Beneficiaries | 4448 |
| Total Submitted Charge Amount | 2145773.03 |
| Total Medicare Allowed Amount | 580347.61 |
| Total Medicare Payment Amount | 451239.64 |
| Total Medicare Standardized Payment Amount | 440861.93 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 14554 |
| Number Of Medicare Beneficiaries With Drug Services | 217 |
| Total Drug Submitted ChargeAmount | 5789.35 |
| Total Drug Medicare AllowedAmount | 3687.73 |
| Total Drug Medicare PaymentAmount | 2891.04 |
| Total Drug Medicare Standardized Payment Amount | 2891.04 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 198 |
| Number Of Medical Services | 7196 |
| Number Of Medicare Beneficiaries With Medical Services | 4448 |
| Total Medical Submitted Charge Amount | 2139983.68 |
| Total Medical Medicare Allowed Amount | 576659.88 |
| Total Medical Medicare Payment Amount | 448348.6 |
| Total Medical Medicare Standardized Payment Amount | 437970.89 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 642 |
| Number Of Beneficiaries Age 65 to 74 | 1558 |
| Number Of Beneficiaries Age 75 to 84 | 1387 |
| Number Of Beneficiaries Age Greater 84 | 861 |
| Number Of Female Beneficiaries | 2825 |
| Number Of Male Beneficiaries | 1623 |
| Number Of Non Hispanic White Beneficiaries | 3866 |
| Number Of Black or African American Beneficiaries | 276 |
| Number Of AsianPacific Islander Beneficiaries | 56 |
| Number Of Hispanic Beneficiaries | 177 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 73 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3438 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1010 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.625 |