| National Provider Identifier [NPI]: | 1013953868 |
| Last Name Of The Provider | JORDAN |
| First Name Of The Provider | NATHAN |
| 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 | 1234 NAPIER AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | ST JOSEPH |
| Zip Code Of The Provider | 49085 |
| 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 | 217 |
| Number Of Services | 4022 |
| Number Of Medicare Beneficiaries | 2614 |
| Total Submitted Charge Amount | 593227 |
| Total Medicare Allowed Amount | 171174.6 |
| Total Medicare Payment Amount | 125287.19 |
| Total Medicare Standardized Payment Amount | 133512.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 217 |
| Number Of Medical Services | 4022 |
| Number Of Medicare Beneficiaries With Medical Services | 2614 |
| Total Medical Submitted Charge Amount | 593227 |
| Total Medical Medicare Allowed Amount | 171174.6 |
| Total Medical Medicare Payment Amount | 125287.19 |
| Total Medical Medicare Standardized Payment Amount | 133512.98 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 615 |
| Number Of Beneficiaries Age 65 to 74 | 839 |
| Number Of Beneficiaries Age 75 to 84 | 706 |
| Number Of Beneficiaries Age Greater 84 | 454 |
| Number Of Female Beneficiaries | 1464 |
| Number Of Male Beneficiaries | 1150 |
| Number Of Non Hispanic White Beneficiaries | 2106 |
| Number Of Black or African American Beneficiaries | 441 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 36 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1720 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 894 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.7585 |