| National Provider Identifier [NPI]: | 1851516868 |
| Last Name Of The Provider | WAIKHOM |
| First Name Of The Provider | SURAJ |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1654 UPHAM DR |
| Street Address 2 Of The Provider | 630 MEANS HALL |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 432101250 |
| 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 | 68 |
| Number Of Services | 2113 |
| Number Of Medicare Beneficiaries | 1638 |
| Total Submitted Charge Amount | 445782 |
| Total Medicare Allowed Amount | 127262.91 |
| Total Medicare Payment Amount | 96457.77 |
| Total Medicare Standardized Payment Amount | 99273.78 |
| 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 | 68 |
| Number Of Medical Services | 2113 |
| Number Of Medicare Beneficiaries With Medical Services | 1638 |
| Total Medical Submitted Charge Amount | 445782 |
| Total Medical Medicare Allowed Amount | 127262.91 |
| Total Medical Medicare Payment Amount | 96457.77 |
| Total Medical Medicare Standardized Payment Amount | 99273.78 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 520 |
| Number Of Beneficiaries Age 65 to 74 | 698 |
| Number Of Beneficiaries Age 75 to 84 | 324 |
| Number Of Beneficiaries Age Greater 84 | 96 |
| Number Of Female Beneficiaries | 786 |
| Number Of Male Beneficiaries | 852 |
| Number Of Non Hispanic White Beneficiaries | 1323 |
| Number Of Black or African American Beneficiaries | 251 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1091 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 547 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 56 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.4604 |