| National Provider Identifier [NPI]: | 1154392363 |
| Last Name Of The Provider | THOMAS |
| First Name Of The Provider | MARC |
| Middle Initial Of The Provider | A |
| 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 | 119 |
| Number Of Services | 19767 |
| Number Of Medicare Beneficiaries | 3084 |
| Total Submitted Charge Amount | 2117941.31 |
| Total Medicare Allowed Amount | 390717.76 |
| Total Medicare Payment Amount | 290011.85 |
| Total Medicare Standardized Payment Amount | 287664.44 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 16162 |
| Number Of Medicare Beneficiaries With Drug Services | 200 |
| Total Drug Submitted ChargeAmount | 37762 |
| Total Drug Medicare AllowedAmount | 5463.15 |
| Total Drug Medicare PaymentAmount | 4276.43 |
| Total Drug Medicare Standardized Payment Amount | 4276.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 116 |
| Number Of Medical Services | 3605 |
| Number Of Medicare Beneficiaries With Medical Services | 3084 |
| Total Medical Submitted Charge Amount | 2080179.31 |
| Total Medical Medicare Allowed Amount | 385254.61 |
| Total Medical Medicare Payment Amount | 285735.42 |
| Total Medical Medicare Standardized Payment Amount | 283388.01 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 560 |
| Number Of Beneficiaries Age 65 to 74 | 1193 |
| Number Of Beneficiaries Age 75 to 84 | 930 |
| Number Of Beneficiaries Age Greater 84 | 401 |
| Number Of Female Beneficiaries | 1797 |
| Number Of Male Beneficiaries | 1287 |
| Number Of Non Hispanic White Beneficiaries | 2320 |
| Number Of Black or African American Beneficiaries | 335 |
| Number Of AsianPacific Islander Beneficiaries | 120 |
| Number Of Hispanic Beneficiaries | 246 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2344 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 740 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.656 |