| National Provider Identifier [NPI]: | 1457319642 |
| Last Name Of The Provider | BODKER |
| First Name Of The Provider | JOHN |
| 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 | 2830 N 3RD ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PHOENIX |
| Zip Code Of The Provider | 850041042 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 133 |
| Number Of Services | 56170 |
| Number Of Medicare Beneficiaries | 1548 |
| Total Submitted Charge Amount | 1044102.86 |
| Total Medicare Allowed Amount | 382096.37 |
| Total Medicare Payment Amount | 291931.99 |
| Total Medicare Standardized Payment Amount | 298125.59 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 54207 |
| Number Of Medicare Beneficiaries With Drug Services | 595 |
| Total Drug Submitted ChargeAmount | 54235.86 |
| Total Drug Medicare AllowedAmount | 10528.63 |
| Total Drug Medicare PaymentAmount | 8245.1 |
| Total Drug Medicare Standardized Payment Amount | 8245.1 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 130 |
| Number Of Medical Services | 1963 |
| Number Of Medicare Beneficiaries With Medical Services | 1548 |
| Total Medical Submitted Charge Amount | 989867 |
| Total Medical Medicare Allowed Amount | 371567.74 |
| Total Medical Medicare Payment Amount | 283686.89 |
| Total Medical Medicare Standardized Payment Amount | 289880.49 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 153 |
| Number Of Beneficiaries Age 65 to 74 | 834 |
| Number Of Beneficiaries Age 75 to 84 | 429 |
| Number Of Beneficiaries Age Greater 84 | 132 |
| Number Of Female Beneficiaries | 729 |
| Number Of Male Beneficiaries | 819 |
| Number Of Non Hispanic White Beneficiaries | 1257 |
| Number Of Black or African American Beneficiaries | 77 |
| Number Of AsianPacific Islander Beneficiaries | 22 |
| Number Of Hispanic Beneficiaries | 152 |
| Number Of American Indian Alaska Native Beneficiaries | 17 |
| Number Of Beneficiaries With Race Not Else where Classified | 23 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1373 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 175 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.1491 |