| National Provider Identifier [NPI]: | 1629080486 |
| Last Name Of The Provider | SHOGREN |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1530 PINE GROVE AVE |
| Street Address 2 Of The Provider | STE 7 |
| City Of The Provider | PORT HURON |
| Zip Code Of The Provider | 48060 |
| 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 | 200 |
| Number Of Services | 7303 |
| Number Of Medicare Beneficiaries | 4082 |
| Total Submitted Charge Amount | 732104 |
| Total Medicare Allowed Amount | 208718.01 |
| Total Medicare Payment Amount | 158054.36 |
| Total Medicare Standardized Payment Amount | 164365.24 |
| 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 | 200 |
| Number Of Medical Services | 7303 |
| Number Of Medicare Beneficiaries With Medical Services | 4082 |
| Total Medical Submitted Charge Amount | 732104 |
| Total Medical Medicare Allowed Amount | 208718.01 |
| Total Medical Medicare Payment Amount | 158054.36 |
| Total Medical Medicare Standardized Payment Amount | 164365.24 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 925 |
| Number Of Beneficiaries Age 65 to 74 | 1466 |
| Number Of Beneficiaries Age 75 to 84 | 1071 |
| Number Of Beneficiaries Age Greater 84 | 620 |
| Number Of Female Beneficiaries | 2667 |
| Number Of Male Beneficiaries | 1415 |
| Number Of Non Hispanic White Beneficiaries | 3846 |
| Number Of Black or African American Beneficiaries | 112 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 70 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 40 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2900 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1182 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.5583 |