| National Provider Identifier [NPI]: | 1023097250 |
| Last Name Of The Provider | SOEIRO |
| First Name Of The Provider | DAMON |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 MEDICAL CENTER BLVD |
| Street Address 2 Of The Provider | CROZER-CHESTER MEDICAL CENTER; DEPT. RADIOLOGY |
| City Of The Provider | UPLAND |
| Zip Code Of The Provider | 190133902 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 126 |
| Number Of Services | 2542 |
| Number Of Medicare Beneficiaries | 1861 |
| Total Submitted Charge Amount | 353652.49 |
| Total Medicare Allowed Amount | 121626.51 |
| Total Medicare Payment Amount | 91576.25 |
| Total Medicare Standardized Payment Amount | 88468.9 |
| 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 | 126 |
| Number Of Medical Services | 2542 |
| Number Of Medicare Beneficiaries With Medical Services | 1861 |
| Total Medical Submitted Charge Amount | 353652.49 |
| Total Medical Medicare Allowed Amount | 121626.51 |
| Total Medical Medicare Payment Amount | 91576.25 |
| Total Medical Medicare Standardized Payment Amount | 88468.9 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 426 |
| Number Of Beneficiaries Age 65 to 74 | 701 |
| Number Of Beneficiaries Age 75 to 84 | 465 |
| Number Of Beneficiaries Age Greater 84 | 269 |
| Number Of Female Beneficiaries | 1119 |
| Number Of Male Beneficiaries | 742 |
| Number Of Non Hispanic White Beneficiaries | 1380 |
| Number Of Black or African American Beneficiaries | 413 |
| Number Of AsianPacific Islander Beneficiaries | 16 |
| Number Of Hispanic Beneficiaries | 30 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1368 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 493 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.6124 |