| National Provider Identifier [NPI]: | 1134113798 |
| Last Name Of The Provider | DEDHIA |
| First Name Of The Provider | CHAMPAK |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 700 QUINCY AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | SCRANTON |
| Zip Code Of The Provider | 185101724 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 151 |
| Number Of Services | 6725 |
| Number Of Medicare Beneficiaries | 3903 |
| Total Submitted Charge Amount | 556897 |
| Total Medicare Allowed Amount | 182222.96 |
| Total Medicare Payment Amount | 139874.74 |
| Total Medicare Standardized Payment Amount | 144959.21 |
| 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 | 151 |
| Number Of Medical Services | 6725 |
| Number Of Medicare Beneficiaries With Medical Services | 3903 |
| Total Medical Submitted Charge Amount | 556897 |
| Total Medical Medicare Allowed Amount | 182222.96 |
| Total Medical Medicare Payment Amount | 139874.74 |
| Total Medical Medicare Standardized Payment Amount | 144959.21 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 716 |
| Number Of Beneficiaries Age 65 to 74 | 1313 |
| Number Of Beneficiaries Age 75 to 84 | 1093 |
| Number Of Beneficiaries Age Greater 84 | 781 |
| Number Of Female Beneficiaries | 2364 |
| Number Of Male Beneficiaries | 1539 |
| Number Of Non Hispanic White Beneficiaries | 3702 |
| Number Of Black or African American Beneficiaries | 66 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 79 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 34 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2755 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1148 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.7003 |