| National Provider Identifier [NPI]: | 1083877278 |
| Last Name Of The Provider | BASS |
| First Name Of The Provider | STACEY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD, PHD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9314 RAMBLEBROOK RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | NOTTINGHAM |
| Zip Code Of The Provider | 212361755 |
| 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 | 141 |
| Number Of Services | 4749 |
| Number Of Medicare Beneficiaries | 995 |
| Total Submitted Charge Amount | 360383 |
| Total Medicare Allowed Amount | 89039.43 |
| Total Medicare Payment Amount | 72155.5 |
| Total Medicare Standardized Payment Amount | 68595.05 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 3293 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 9879 |
| Total Drug Medicare AllowedAmount | 666.14 |
| Total Drug Medicare PaymentAmount | 522.33 |
| Total Drug Medicare Standardized Payment Amount | 522.33 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 138 |
| Number Of Medical Services | 1456 |
| Number Of Medicare Beneficiaries With Medical Services | 995 |
| Total Medical Submitted Charge Amount | 350504 |
| Total Medical Medicare Allowed Amount | 88373.29 |
| Total Medical Medicare Payment Amount | 71633.17 |
| Total Medical Medicare Standardized Payment Amount | 68072.72 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 152 |
| Number Of Beneficiaries Age 65 to 74 | 354 |
| Number Of Beneficiaries Age 75 to 84 | 274 |
| Number Of Beneficiaries Age Greater 84 | 215 |
| Number Of Female Beneficiaries | 635 |
| Number Of Male Beneficiaries | 360 |
| Number Of Non Hispanic White Beneficiaries | 885 |
| Number Of Black or African American Beneficiaries | 47 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 43 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 670 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 325 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.71 |