| National Provider Identifier [NPI]: | 1548264872 |
| Last Name Of The Provider | ALFONSO |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3525 OLENTANGY RIVER RD |
| Street Address 2 Of The Provider | STE 5360 |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 432143937 |
| 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 | 159 |
| Number Of Services | 5330 |
| Number Of Medicare Beneficiaries | 3901 |
| Total Submitted Charge Amount | 622849 |
| Total Medicare Allowed Amount | 160075.73 |
| Total Medicare Payment Amount | 123631.18 |
| Total Medicare Standardized Payment Amount | 128027.82 |
| 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 | 159 |
| Number Of Medical Services | 5330 |
| Number Of Medicare Beneficiaries With Medical Services | 3901 |
| Total Medical Submitted Charge Amount | 622849 |
| Total Medical Medicare Allowed Amount | 160075.73 |
| Total Medical Medicare Payment Amount | 123631.18 |
| Total Medical Medicare Standardized Payment Amount | 128027.82 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 802 |
| Number Of Beneficiaries Age 65 to 74 | 1322 |
| Number Of Beneficiaries Age 75 to 84 | 1090 |
| Number Of Beneficiaries Age Greater 84 | 687 |
| Number Of Female Beneficiaries | 2272 |
| Number Of Male Beneficiaries | 1629 |
| Number Of Non Hispanic White Beneficiaries | 3610 |
| Number Of Black or African American Beneficiaries | 184 |
| Number Of AsianPacific Islander Beneficiaries | 33 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 42 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2773 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1128 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.7817 |