| National Provider Identifier [NPI]: | 1245437623 |
| Last Name Of The Provider | CAOVAN |
| First Name Of The Provider | DOMINIQUE |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3999 RICHMOND RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BEACHWOOD |
| Zip Code Of The Provider | 441226046 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 91 |
| Number Of Services | 3983 |
| Number Of Medicare Beneficiaries | 2613 |
| Total Submitted Charge Amount | 343608 |
| Total Medicare Allowed Amount | 110402.82 |
| Total Medicare Payment Amount | 81670.8 |
| Total Medicare Standardized Payment Amount | 84727.59 |
| 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 | 91 |
| Number Of Medical Services | 3983 |
| Number Of Medicare Beneficiaries With Medical Services | 2613 |
| Total Medical Submitted Charge Amount | 343608 |
| Total Medical Medicare Allowed Amount | 110402.82 |
| Total Medical Medicare Payment Amount | 81670.8 |
| Total Medical Medicare Standardized Payment Amount | 84727.59 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 559 |
| Number Of Beneficiaries Age 65 to 74 | 698 |
| Number Of Beneficiaries Age 75 to 84 | 674 |
| Number Of Beneficiaries Age Greater 84 | 682 |
| Number Of Female Beneficiaries | 1585 |
| Number Of Male Beneficiaries | 1028 |
| Number Of Non Hispanic White Beneficiaries | 1976 |
| Number Of Black or African American Beneficiaries | 545 |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 38 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 34 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1713 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 900 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 31 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 46 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 35 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 62 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 16 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.1185 |