| National Provider Identifier [NPI]: | 1124018221 |
| Last Name Of The Provider | DETESO |
| First Name Of The Provider | DAMON |
| 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 | 211 CHURCH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SARATOGA SPGS |
| Zip Code Of The Provider | 128661046 |
| 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 | 193 |
| Number Of Services | 6049 |
| Number Of Medicare Beneficiaries | 3689 |
| Total Submitted Charge Amount | 632976.7 |
| Total Medicare Allowed Amount | 185809.06 |
| Total Medicare Payment Amount | 146596.01 |
| Total Medicare Standardized Payment Amount | 153176.4 |
| 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 | 193 |
| Number Of Medical Services | 6049 |
| Number Of Medicare Beneficiaries With Medical Services | 3689 |
| Total Medical Submitted Charge Amount | 632976.7 |
| Total Medical Medicare Allowed Amount | 185809.06 |
| Total Medical Medicare Payment Amount | 146596.01 |
| Total Medical Medicare Standardized Payment Amount | 153176.4 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 787 |
| Number Of Beneficiaries Age 65 to 74 | 1305 |
| Number Of Beneficiaries Age 75 to 84 | 952 |
| Number Of Beneficiaries Age Greater 84 | 645 |
| Number Of Female Beneficiaries | 2272 |
| Number Of Male Beneficiaries | 1417 |
| Number Of Non Hispanic White Beneficiaries | 3459 |
| Number Of Black or African American Beneficiaries | 75 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 77 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 58 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2550 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1139 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.5551 |