| National Provider Identifier [NPI]: | 1073540662 |
| Last Name Of The Provider | DECOSTA |
| First Name Of The Provider | DONNA |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7253 AMBASSADOR RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BALTIMORE |
| Zip Code Of The Provider | 212442710 |
| 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 | 129 |
| Number Of Services | 27774 |
| Number Of Medicare Beneficiaries | 3415 |
| Total Submitted Charge Amount | 1231870.23 |
| Total Medicare Allowed Amount | 435613.04 |
| Total Medicare Payment Amount | 324790.84 |
| Total Medicare Standardized Payment Amount | 304716.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 23185 |
| Number Of Medicare Beneficiaries With Drug Services | 226 |
| Total Drug Submitted ChargeAmount | 5332.55 |
| Total Drug Medicare AllowedAmount | 4279.43 |
| Total Drug Medicare PaymentAmount | 2961.09 |
| Total Drug Medicare Standardized Payment Amount | 2961.09 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 128 |
| Number Of Medical Services | 4589 |
| Number Of Medicare Beneficiaries With Medical Services | 3414 |
| Total Medical Submitted Charge Amount | 1226537.68 |
| Total Medical Medicare Allowed Amount | 431333.61 |
| Total Medical Medicare Payment Amount | 321829.75 |
| Total Medical Medicare Standardized Payment Amount | 301755.18 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 429 |
| Number Of Beneficiaries Age 65 to 74 | 1678 |
| Number Of Beneficiaries Age 75 to 84 | 960 |
| Number Of Beneficiaries Age Greater 84 | 348 |
| Number Of Female Beneficiaries | 2317 |
| Number Of Male Beneficiaries | 1098 |
| Number Of Non Hispanic White Beneficiaries | 2807 |
| Number Of Black or African American Beneficiaries | 429 |
| Number Of AsianPacific Islander Beneficiaries | 89 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 45 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3010 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 405 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1408 |