| National Provider Identifier [NPI]: | 1205983004 |
| Last Name Of The Provider | PARK |
| First Name Of The Provider | DEAN |
| 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 | 211 N EDDY ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SOUTH BEND |
| Zip Code Of The Provider | 466172808 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 101 |
| Number Of Services | 38257 |
| Number Of Medicare Beneficiaries | 346 |
| Total Submitted Charge Amount | 2041735 |
| Total Medicare Allowed Amount | 1025854.58 |
| Total Medicare Payment Amount | 797988.55 |
| Total Medicare Standardized Payment Amount | 802532.36 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 51 |
| Number Of Drug Services | 35715 |
| Number Of Medicare Beneficiaries With Drug Services | 81 |
| Total Drug Submitted ChargeAmount | 1705405 |
| Total Drug Medicare AllowedAmount | 855454.56 |
| Total Drug Medicare PaymentAmount | 669635.64 |
| Total Drug Medicare Standardized Payment Amount | 669635.64 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 50 |
| Number Of Medical Services | 2542 |
| Number Of Medicare Beneficiaries With Medical Services | 346 |
| Total Medical Submitted Charge Amount | 336330 |
| Total Medical Medicare Allowed Amount | 170400.02 |
| Total Medical Medicare Payment Amount | 128352.91 |
| Total Medical Medicare Standardized Payment Amount | 132896.72 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 28 |
| Number Of Beneficiaries Age 65 to 74 | 134 |
| Number Of Beneficiaries Age 75 to 84 | 134 |
| Number Of Beneficiaries Age Greater 84 | 50 |
| Number Of Female Beneficiaries | 185 |
| Number Of Male Beneficiaries | 161 |
| Number Of Non Hispanic White Beneficiaries | 314 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 314 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 32 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 40 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.5616 |