| National Provider Identifier [NPI]: | 1871559302 |
| Last Name Of The Provider | BESSETTE |
| First Name Of The Provider | JEFFREY |
| 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 DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT WAYNE |
| Zip Code Of The Provider | 468451702 |
| 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 | 186 |
| Number Of Services | 5052 |
| Number Of Medicare Beneficiaries | 2826 |
| Total Submitted Charge Amount | 842677.5 |
| Total Medicare Allowed Amount | 234247 |
| Total Medicare Payment Amount | 177633.59 |
| Total Medicare Standardized Payment Amount | 186324.88 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 1154 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 13692.5 |
| Total Drug Medicare AllowedAmount | 664.03 |
| Total Drug Medicare PaymentAmount | 520.58 |
| Total Drug Medicare Standardized Payment Amount | 520.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 183 |
| Number Of Medical Services | 3898 |
| Number Of Medicare Beneficiaries With Medical Services | 2826 |
| Total Medical Submitted Charge Amount | 828985 |
| Total Medical Medicare Allowed Amount | 233582.97 |
| Total Medical Medicare Payment Amount | 177113.01 |
| Total Medical Medicare Standardized Payment Amount | 185804.3 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 688 |
| Number Of Beneficiaries Age 65 to 74 | 941 |
| Number Of Beneficiaries Age 75 to 84 | 747 |
| Number Of Beneficiaries Age Greater 84 | 450 |
| Number Of Female Beneficiaries | 1709 |
| Number Of Male Beneficiaries | 1117 |
| Number Of Non Hispanic White Beneficiaries | 2584 |
| Number Of Black or African American Beneficiaries | 152 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 50 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2011 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 815 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 15 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5557 |