| National Provider Identifier [NPI]: | 1730155854 |
| Last Name Of The Provider | DATTA |
| First Name Of The Provider | JAYDIP |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3950 AUSTELL RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | AUSTELL |
| Zip Code Of The Provider | 301061121 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 133 |
| Number Of Services | 3674 |
| Number Of Medicare Beneficiaries | 2708 |
| Total Submitted Charge Amount | 686450 |
| Total Medicare Allowed Amount | 141832.2 |
| Total Medicare Payment Amount | 109935.85 |
| Total Medicare Standardized Payment Amount | 111107.53 |
| 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 | 133 |
| Number Of Medical Services | 3674 |
| Number Of Medicare Beneficiaries With Medical Services | 2708 |
| Total Medical Submitted Charge Amount | 686450 |
| Total Medical Medicare Allowed Amount | 141832.2 |
| Total Medical Medicare Payment Amount | 109935.85 |
| Total Medical Medicare Standardized Payment Amount | 111107.53 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 538 |
| Number Of Beneficiaries Age 65 to 74 | 1015 |
| Number Of Beneficiaries Age 75 to 84 | 742 |
| Number Of Beneficiaries Age Greater 84 | 413 |
| Number Of Female Beneficiaries | 1548 |
| Number Of Male Beneficiaries | 1160 |
| Number Of Non Hispanic White Beneficiaries | 2096 |
| Number Of Black or African American Beneficiaries | 491 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 70 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 26 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2046 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 662 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 50 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.0738 |