| National Provider Identifier [NPI]: | 1174573190 |
| Last Name Of The Provider | OTT |
| First Name Of The Provider | INGRID |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2141 K ST NW |
| Street Address 2 Of The Provider | STE 900 |
| City Of The Provider | WASHINGTON |
| Zip Code Of The Provider | 200371810 |
| State Code Of The Provider | DC |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 79 |
| Number Of Services | 3181 |
| Number Of Medicare Beneficiaries | 839 |
| Total Submitted Charge Amount | 632189 |
| Total Medicare Allowed Amount | 202592.52 |
| Total Medicare Payment Amount | 166354.29 |
| Total Medicare Standardized Payment Amount | 143997.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1692 |
| Number Of Medicare Beneficiaries With Drug Services | 83 |
| Total Drug Submitted ChargeAmount | 9679 |
| Total Drug Medicare AllowedAmount | 2350.41 |
| Total Drug Medicare PaymentAmount | 1818.6 |
| Total Drug Medicare Standardized Payment Amount | 1818.6 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 77 |
| Number Of Medical Services | 1489 |
| Number Of Medicare Beneficiaries With Medical Services | 839 |
| Total Medical Submitted Charge Amount | 622510 |
| Total Medical Medicare Allowed Amount | 200242.11 |
| Total Medical Medicare Payment Amount | 164535.69 |
| Total Medical Medicare Standardized Payment Amount | 142178.78 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 539 |
| Number Of Beneficiaries Age 75 to 84 | 233 |
| Number Of Beneficiaries Age Greater 84 | 46 |
| Number Of Female Beneficiaries | 748 |
| Number Of Male Beneficiaries | 91 |
| Number Of Non Hispanic White Beneficiaries | 653 |
| Number Of Black or African American Beneficiaries | 82 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 37 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 36 |
| Number Of Beneficiaries With Medicare Only Entitlement | 825 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 14 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 4 |
| Percent Of With Chronic Kidney Disease | 8 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 3 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 13 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 41 |
| Percent Of With Ischemic Heart Disease | 12 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.688 |