| National Provider Identifier [NPI]: | 1265469332 |
| Last Name Of The Provider | FREDERICK |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3346 LENNON RD |
| Street Address 2 Of The Provider | SUITE 2 |
| City Of The Provider | FLINT |
| Zip Code Of The Provider | 485071082 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 150 |
| Number Of Services | 49963 |
| Number Of Medicare Beneficiaries | 1060 |
| Total Submitted Charge Amount | 688438.25 |
| Total Medicare Allowed Amount | 301561.43 |
| Total Medicare Payment Amount | 228385.88 |
| Total Medicare Standardized Payment Amount | 245554.01 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 47420 |
| Number Of Medicare Beneficiaries With Drug Services | 457 |
| Total Drug Submitted ChargeAmount | 27053.75 |
| Total Drug Medicare AllowedAmount | 10053.21 |
| Total Drug Medicare PaymentAmount | 7867.53 |
| Total Drug Medicare Standardized Payment Amount | 7867.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 148 |
| Number Of Medical Services | 2543 |
| Number Of Medicare Beneficiaries With Medical Services | 1060 |
| Total Medical Submitted Charge Amount | 661384.5 |
| Total Medical Medicare Allowed Amount | 291508.22 |
| Total Medical Medicare Payment Amount | 220518.35 |
| Total Medical Medicare Standardized Payment Amount | 237686.48 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 178 |
| Number Of Beneficiaries Age 65 to 74 | 466 |
| Number Of Beneficiaries Age 75 to 84 | 306 |
| Number Of Beneficiaries Age Greater 84 | 110 |
| Number Of Female Beneficiaries | 646 |
| Number Of Male Beneficiaries | 414 |
| Number Of Non Hispanic White Beneficiaries | 901 |
| Number Of Black or African American Beneficiaries | 125 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 915 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 145 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.4137 |