| National Provider Identifier [NPI]: | 1922199058 |
| Last Name Of The Provider | PARK |
| First Name Of The Provider | JENNIFER |
| 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 | 8001 FORBES PL |
| Street Address 2 Of The Provider | SUITE 103 |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 221512208 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 153 |
| Number Of Services | 5529 |
| Number Of Medicare Beneficiaries | 3366 |
| Total Submitted Charge Amount | 1110090 |
| Total Medicare Allowed Amount | 346122.83 |
| Total Medicare Payment Amount | 289838.81 |
| Total Medicare Standardized Payment Amount | 271710.16 |
| 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 | 153 |
| Number Of Medical Services | 5529 |
| Number Of Medicare Beneficiaries With Medical Services | 3366 |
| Total Medical Submitted Charge Amount | 1110090 |
| Total Medical Medicare Allowed Amount | 346122.83 |
| Total Medical Medicare Payment Amount | 289838.81 |
| Total Medical Medicare Standardized Payment Amount | 271710.16 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 329 |
| Number Of Beneficiaries Age 65 to 74 | 1649 |
| Number Of Beneficiaries Age 75 to 84 | 920 |
| Number Of Beneficiaries Age Greater 84 | 468 |
| Number Of Female Beneficiaries | 2473 |
| Number Of Male Beneficiaries | 893 |
| Number Of Non Hispanic White Beneficiaries | 2298 |
| Number Of Black or African American Beneficiaries | 665 |
| Number Of AsianPacific Islander Beneficiaries | 144 |
| Number Of Hispanic Beneficiaries | 183 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 76 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2895 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 471 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.2766 |