| National Provider Identifier [NPI]: | 1972708345 |
| Last Name Of The Provider | DEMARTINI |
| First Name Of The Provider | NICHOLAS |
| 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 | 5008 BRITTONFIELD PKWY |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | EAST SYRACUSE |
| Zip Code Of The Provider | 130579248 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 140 |
| Number Of Services | 5722 |
| Number Of Medicare Beneficiaries | 2893 |
| Total Submitted Charge Amount | 379505.5 |
| Total Medicare Allowed Amount | 164024.86 |
| Total Medicare Payment Amount | 131506.84 |
| Total Medicare Standardized Payment Amount | 138306.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 1285 |
| Number Of Medicare Beneficiaries With Drug Services | 47 |
| Total Drug Submitted ChargeAmount | 6152.5 |
| Total Drug Medicare AllowedAmount | 307.9 |
| Total Drug Medicare PaymentAmount | 227.75 |
| Total Drug Medicare Standardized Payment Amount | 227.75 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 137 |
| Number Of Medical Services | 4437 |
| Number Of Medicare Beneficiaries With Medical Services | 2893 |
| Total Medical Submitted Charge Amount | 373353 |
| Total Medical Medicare Allowed Amount | 163716.96 |
| Total Medical Medicare Payment Amount | 131279.09 |
| Total Medical Medicare Standardized Payment Amount | 138078.78 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 462 |
| Number Of Beneficiaries Age 65 to 74 | 1148 |
| Number Of Beneficiaries Age 75 to 84 | 810 |
| Number Of Beneficiaries Age Greater 84 | 473 |
| Number Of Female Beneficiaries | 2125 |
| Number Of Male Beneficiaries | 768 |
| Number Of Non Hispanic White Beneficiaries | 2604 |
| Number Of Black or African American Beneficiaries | 155 |
| Number Of AsianPacific Islander Beneficiaries | 26 |
| Number Of Hispanic Beneficiaries | 36 |
| Number Of American Indian Alaska Native Beneficiaries | 13 |
| Number Of Beneficiaries With Race Not Else where Classified | 59 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2326 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 567 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.3471 |