| National Provider Identifier [NPI]: | 1053382234 |
| Last Name Of The Provider | HEATWOLE |
| First Name Of The Provider | ERIC |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5001 US HIGHWAY 30 W STE D |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT WAYNE |
| Zip Code Of The Provider | 468189701 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 280 |
| Number Of Services | 4865 |
| Number Of Medicare Beneficiaries | 3101 |
| Total Submitted Charge Amount | 963685.83 |
| Total Medicare Allowed Amount | 273603.19 |
| Total Medicare Payment Amount | 207860.04 |
| Total Medicare Standardized Payment Amount | 221406.19 |
| 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 | 280 |
| Number Of Medical Services | 4865 |
| Number Of Medicare Beneficiaries With Medical Services | 3101 |
| Total Medical Submitted Charge Amount | 963685.83 |
| Total Medical Medicare Allowed Amount | 273603.19 |
| Total Medical Medicare Payment Amount | 207860.04 |
| Total Medical Medicare Standardized Payment Amount | 221406.19 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 616 |
| Number Of Beneficiaries Age 65 to 74 | 1114 |
| Number Of Beneficiaries Age 75 to 84 | 863 |
| Number Of Beneficiaries Age Greater 84 | 508 |
| Number Of Female Beneficiaries | 1720 |
| Number Of Male Beneficiaries | 1381 |
| Number Of Non Hispanic White Beneficiaries | 2792 |
| Number Of Black or African American Beneficiaries | 198 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 60 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 34 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2262 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 839 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.93 |