| National Provider Identifier [NPI]: | 1538284153 |
| Last Name Of The Provider | GILLIAM |
| First Name Of The Provider | JEREMY |
| Middle Initial Of The Provider | D |
| 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 | 186 |
| Number Of Services | 6982 |
| Number Of Medicare Beneficiaries | 4544 |
| Total Submitted Charge Amount | 619876.14 |
| Total Medicare Allowed Amount | 184243.82 |
| Total Medicare Payment Amount | 145517.6 |
| Total Medicare Standardized Payment Amount | 152376.55 |
| 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 | 186 |
| Number Of Medical Services | 6982 |
| Number Of Medicare Beneficiaries With Medical Services | 4544 |
| Total Medical Submitted Charge Amount | 619876.14 |
| Total Medical Medicare Allowed Amount | 184243.82 |
| Total Medical Medicare Payment Amount | 145517.6 |
| Total Medical Medicare Standardized Payment Amount | 152376.55 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 844 |
| Number Of Beneficiaries Age 65 to 74 | 1745 |
| Number Of Beneficiaries Age 75 to 84 | 1261 |
| Number Of Beneficiaries Age Greater 84 | 694 |
| Number Of Female Beneficiaries | 3079 |
| Number Of Male Beneficiaries | 1465 |
| Number Of Non Hispanic White Beneficiaries | 4260 |
| Number Of Black or African American Beneficiaries | 190 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 44 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 30 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3422 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1122 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4473 |