| National Provider Identifier [NPI]: | 1053324574 |
| Last Name Of The Provider | CHEN |
| First Name Of The Provider | EDEM |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4500 SAN PABLO RD S |
| Street Address 2 Of The Provider | |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322241865 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 152 |
| Number Of Services | 7181 |
| Number Of Medicare Beneficiaries | 4206 |
| Total Submitted Charge Amount | 792974 |
| Total Medicare Allowed Amount | 223763.99 |
| Total Medicare Payment Amount | 159132.74 |
| Total Medicare Standardized Payment Amount | 160979.72 |
| 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 | 152 |
| Number Of Medical Services | 7181 |
| Number Of Medicare Beneficiaries With Medical Services | 4206 |
| Total Medical Submitted Charge Amount | 792974 |
| Total Medical Medicare Allowed Amount | 223763.99 |
| Total Medical Medicare Payment Amount | 159132.74 |
| Total Medical Medicare Standardized Payment Amount | 160979.72 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 1037 |
| Number Of Beneficiaries Age 65 to 74 | 1158 |
| Number Of Beneficiaries Age 75 to 84 | 1135 |
| Number Of Beneficiaries Age Greater 84 | 876 |
| Number Of Female Beneficiaries | 2435 |
| Number Of Male Beneficiaries | 1771 |
| Number Of Non Hispanic White Beneficiaries | 2818 |
| Number Of Black or African American Beneficiaries | 766 |
| Number Of AsianPacific Islander Beneficiaries | 75 |
| Number Of Hispanic Beneficiaries | 492 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2542 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1664 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 31 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 49 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 62 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.3098 |