| National Provider Identifier [NPI]: | 1730107525 |
| Last Name Of The Provider | WIDLUS |
| First Name Of The Provider | DAVID |
| 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 | 22 S GREENE ST |
| Street Address 2 Of The Provider | ROOM N2E16 |
| City Of The Provider | BALTIMORE |
| Zip Code Of The Provider | 212011544 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 108 |
| Number Of Services | 10419 |
| Number Of Medicare Beneficiaries | 5089 |
| Total Submitted Charge Amount | 492032 |
| Total Medicare Allowed Amount | 185912.24 |
| Total Medicare Payment Amount | 143170.55 |
| Total Medicare Standardized Payment Amount | 133901.94 |
| 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 | 108 |
| Number Of Medical Services | 10419 |
| Number Of Medicare Beneficiaries With Medical Services | 5089 |
| Total Medical Submitted Charge Amount | 492032 |
| Total Medical Medicare Allowed Amount | 185912.24 |
| Total Medical Medicare Payment Amount | 143170.55 |
| Total Medical Medicare Standardized Payment Amount | 133901.94 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 1262 |
| Number Of Beneficiaries Age 65 to 74 | 1753 |
| Number Of Beneficiaries Age 75 to 84 | 1350 |
| Number Of Beneficiaries Age Greater 84 | 724 |
| Number Of Female Beneficiaries | 2978 |
| Number Of Male Beneficiaries | 2111 |
| Number Of Non Hispanic White Beneficiaries | 2134 |
| Number Of Black or African American Beneficiaries | 2818 |
| Number Of AsianPacific Islander Beneficiaries | 50 |
| Number Of Hispanic Beneficiaries | 44 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 3313 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1776 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 2.1947 |