| National Provider Identifier [NPI]: | 1972521979 |
| Last Name Of The Provider | CHAMBERS |
| First Name Of The Provider | THEODORE |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2722 MERRILEE DR |
| Street Address 2 Of The Provider | SUITE 230 |
| City Of The Provider | FAIRFAX |
| Zip Code Of The Provider | 220314400 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 83456 |
| Number Of Medicare Beneficiaries | 481 |
| Total Submitted Charge Amount | 14443967 |
| Total Medicare Allowed Amount | 4742395.97 |
| Total Medicare Payment Amount | 3689730.42 |
| Total Medicare Standardized Payment Amount | 3124254.23 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 78749 |
| Number Of Medicare Beneficiaries With Drug Services | 420 |
| Total Drug Submitted ChargeAmount | 115280 |
| Total Drug Medicare AllowedAmount | 37465.76 |
| Total Drug Medicare PaymentAmount | 29217.86 |
| Total Drug Medicare Standardized Payment Amount | 29217.86 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 45 |
| Number Of Medical Services | 4707 |
| Number Of Medicare Beneficiaries With Medical Services | 480 |
| Total Medical Submitted Charge Amount | 14328687 |
| Total Medical Medicare Allowed Amount | 4704930.21 |
| Total Medical Medicare Payment Amount | 3660512.56 |
| Total Medical Medicare Standardized Payment Amount | 3095036.37 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 193 |
| Number Of Beneficiaries Age 65 to 74 | 138 |
| Number Of Beneficiaries Age 75 to 84 | 105 |
| Number Of Beneficiaries Age Greater 84 | 45 |
| Number Of Female Beneficiaries | 227 |
| Number Of Male Beneficiaries | 254 |
| Number Of Non Hispanic White Beneficiaries | 77 |
| Number Of Black or African American Beneficiaries | 318 |
| Number Of AsianPacific Islander Beneficiaries | 25 |
| Number Of Hispanic Beneficiaries | 47 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 227 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 254 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 61 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 71 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 7.7742 |