| National Provider Identifier [NPI]: | 1023062130 |
| Last Name Of The Provider | MATTISON |
| First Name Of The Provider | GREGG |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3707 NEW VISION DRIVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT WAYNE |
| Zip Code Of The Provider | 468955602 |
| 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 | 170 |
| Number Of Services | 4136 |
| Number Of Medicare Beneficiaries | 3055 |
| Total Submitted Charge Amount | 496563.63 |
| Total Medicare Allowed Amount | 133255.58 |
| Total Medicare Payment Amount | 99449.65 |
| Total Medicare Standardized Payment Amount | 106520.25 |
| 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 | 170 |
| Number Of Medical Services | 4136 |
| Number Of Medicare Beneficiaries With Medical Services | 3055 |
| Total Medical Submitted Charge Amount | 496563.63 |
| Total Medical Medicare Allowed Amount | 133255.58 |
| Total Medical Medicare Payment Amount | 99449.65 |
| Total Medical Medicare Standardized Payment Amount | 106520.25 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 650 |
| Number Of Beneficiaries Age 65 to 74 | 1099 |
| Number Of Beneficiaries Age 75 to 84 | 839 |
| Number Of Beneficiaries Age Greater 84 | 467 |
| Number Of Female Beneficiaries | 1853 |
| Number Of Male Beneficiaries | 1202 |
| Number Of Non Hispanic White Beneficiaries | 2847 |
| Number Of Black or African American Beneficiaries | 110 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 41 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 42 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2287 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 768 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.4114 |