| National Provider Identifier [NPI]: | 1134179906 |
| Last Name Of The Provider | BIDWELL |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3535 SOUTHERN BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | KETTERING |
| Zip Code Of The Provider | 454291221 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 163 |
| Number Of Services | 12946 |
| Number Of Medicare Beneficiaries | 3112 |
| Total Submitted Charge Amount | 795425 |
| Total Medicare Allowed Amount | 198343.48 |
| Total Medicare Payment Amount | 149763.78 |
| Total Medicare Standardized Payment Amount | 155954.6 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 8700 |
| Number Of Medicare Beneficiaries With Drug Services | 83 |
| Total Drug Submitted ChargeAmount | 2436 |
| Total Drug Medicare AllowedAmount | 1622.7 |
| Total Drug Medicare PaymentAmount | 1272.23 |
| Total Drug Medicare Standardized Payment Amount | 1272.23 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 162 |
| Number Of Medical Services | 4246 |
| Number Of Medicare Beneficiaries With Medical Services | 3112 |
| Total Medical Submitted Charge Amount | 792989 |
| Total Medical Medicare Allowed Amount | 196720.78 |
| Total Medical Medicare Payment Amount | 148491.55 |
| Total Medical Medicare Standardized Payment Amount | 154682.37 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 766 |
| Number Of Beneficiaries Age 65 to 74 | 1087 |
| Number Of Beneficiaries Age 75 to 84 | 833 |
| Number Of Beneficiaries Age Greater 84 | 426 |
| Number Of Female Beneficiaries | 1846 |
| Number Of Male Beneficiaries | 1266 |
| Number Of Non Hispanic White Beneficiaries | 2658 |
| Number Of Black or African American Beneficiaries | 365 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 22 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 49 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2282 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 830 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.619 |