| National Provider Identifier [NPI]: | 1740250323 |
| Last Name Of The Provider | NUSSDORFER |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2170 SOUTH AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | S LAKE TAHOE |
| Zip Code Of The Provider | 961507026 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 175 |
| Number Of Services | 3799 |
| Number Of Medicare Beneficiaries | 2295 |
| Total Submitted Charge Amount | 362985.08 |
| Total Medicare Allowed Amount | 118395.69 |
| Total Medicare Payment Amount | 89285.02 |
| Total Medicare Standardized Payment Amount | 90991.04 |
| 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 | 175 |
| Number Of Medical Services | 3799 |
| Number Of Medicare Beneficiaries With Medical Services | 2295 |
| Total Medical Submitted Charge Amount | 362985.08 |
| Total Medical Medicare Allowed Amount | 118395.69 |
| Total Medical Medicare Payment Amount | 89285.02 |
| Total Medical Medicare Standardized Payment Amount | 90991.04 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 318 |
| Number Of Beneficiaries Age 65 to 74 | 925 |
| Number Of Beneficiaries Age 75 to 84 | 645 |
| Number Of Beneficiaries Age Greater 84 | 407 |
| Number Of Female Beneficiaries | 1269 |
| Number Of Male Beneficiaries | 1026 |
| Number Of Non Hispanic White Beneficiaries | 2032 |
| Number Of Black or African American Beneficiaries | 65 |
| Number Of AsianPacific Islander Beneficiaries | 24 |
| Number Of Hispanic Beneficiaries | 121 |
| Number Of American Indian Alaska Native Beneficiaries | 24 |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1933 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 362 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.5979 |