| National Provider Identifier [NPI]: | 1306987995 |
| Last Name Of The Provider | SUBHAWONG |
| First Name Of The Provider | TY |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 601 N CAROLINE ST |
| Street Address 2 Of The Provider | MUSCULOSKELETAL RADIOLOGY , JHOC 5TH FLOOR |
| City Of The Provider | BALTIMORE |
| Zip Code Of The Provider | 212870006 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 102 |
| Number Of Services | 4185 |
| Number Of Medicare Beneficiaries | 2390 |
| Total Submitted Charge Amount | 376250.67 |
| Total Medicare Allowed Amount | 84365.17 |
| Total Medicare Payment Amount | 60553.47 |
| Total Medicare Standardized Payment Amount | 55418.74 |
| 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 | 102 |
| Number Of Medical Services | 4185 |
| Number Of Medicare Beneficiaries With Medical Services | 2390 |
| Total Medical Submitted Charge Amount | 376250.67 |
| Total Medical Medicare Allowed Amount | 84365.17 |
| Total Medical Medicare Payment Amount | 60553.47 |
| Total Medical Medicare Standardized Payment Amount | 55418.74 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 561 |
| Number Of Beneficiaries Age 65 to 74 | 998 |
| Number Of Beneficiaries Age 75 to 84 | 629 |
| Number Of Beneficiaries Age Greater 84 | 202 |
| Number Of Female Beneficiaries | 1416 |
| Number Of Male Beneficiaries | 974 |
| Number Of Non Hispanic White Beneficiaries | 1026 |
| Number Of Black or African American Beneficiaries | 318 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 991 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 34 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1225 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1165 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 19 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.8509 |