| National Provider Identifier [NPI]: | 1851590061 |
| Last Name Of The Provider | BUSSEY |
| First Name Of The Provider | LARA |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1724 MARTINS LN |
| Street Address 2 Of The Provider | |
| City Of The Provider | GLADWYNE |
| Zip Code Of The Provider | 190351122 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 138 |
| Number Of Services | 4877 |
| Number Of Medicare Beneficiaries | 2676 |
| Total Submitted Charge Amount | 361771 |
| Total Medicare Allowed Amount | 141376.49 |
| Total Medicare Payment Amount | 113628.02 |
| Total Medicare Standardized Payment Amount | 109287.29 |
| 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 | 138 |
| Number Of Medical Services | 4877 |
| Number Of Medicare Beneficiaries With Medical Services | 2676 |
| Total Medical Submitted Charge Amount | 361771 |
| Total Medical Medicare Allowed Amount | 141376.49 |
| Total Medical Medicare Payment Amount | 113628.02 |
| Total Medical Medicare Standardized Payment Amount | 109287.29 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 491 |
| Number Of Beneficiaries Age 65 to 74 | 996 |
| Number Of Beneficiaries Age 75 to 84 | 762 |
| Number Of Beneficiaries Age Greater 84 | 427 |
| Number Of Female Beneficiaries | 1726 |
| Number Of Male Beneficiaries | 950 |
| Number Of Non Hispanic White Beneficiaries | 2438 |
| Number Of Black or African American Beneficiaries | 149 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 43 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 34 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2108 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 568 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5726 |