| National Provider Identifier [NPI]: | 1215176573 |
| Last Name Of The Provider | PARK |
| First Name Of The Provider | CHRISTINE |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 13355 E 10 MILE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | WARREN |
| Zip Code Of The Provider | 480892048 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 170 |
| Number Of Services | 6258 |
| Number Of Medicare Beneficiaries | 4459 |
| Total Submitted Charge Amount | 721541 |
| Total Medicare Allowed Amount | 264598.01 |
| Total Medicare Payment Amount | 201143.83 |
| Total Medicare Standardized Payment Amount | 199586.21 |
| 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 | 170 |
| Number Of Medical Services | 6258 |
| Number Of Medicare Beneficiaries With Medical Services | 4459 |
| Total Medical Submitted Charge Amount | 721541 |
| Total Medical Medicare Allowed Amount | 264598.01 |
| Total Medical Medicare Payment Amount | 201143.83 |
| Total Medical Medicare Standardized Payment Amount | 199586.21 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 1114 |
| Number Of Beneficiaries Age 65 to 74 | 1357 |
| Number Of Beneficiaries Age 75 to 84 | 1168 |
| Number Of Beneficiaries Age Greater 84 | 820 |
| Number Of Female Beneficiaries | 2573 |
| Number Of Male Beneficiaries | 1886 |
| Number Of Non Hispanic White Beneficiaries | 3505 |
| Number Of Black or African American Beneficiaries | 668 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 161 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 64 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2929 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1530 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 48 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 45 |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 66 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 59 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 18 |
| Average HCC Risk Score Of Beneficiaries | 2.1953 |