| National Provider Identifier [NPI]: | 1811070584 |
| Last Name Of The Provider | SAMUELSON |
| First Name Of The Provider | DONALD |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 255 W LANCASTER AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | PAOLI |
| Zip Code Of The Provider | 193011763 |
| 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 | 130 |
| Number Of Services | 4805 |
| Number Of Medicare Beneficiaries | 2996 |
| Total Submitted Charge Amount | 576920.77 |
| Total Medicare Allowed Amount | 134790.03 |
| Total Medicare Payment Amount | 106839.36 |
| Total Medicare Standardized Payment Amount | 102064.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 152 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 635.77 |
| Total Drug Medicare AllowedAmount | 62.02 |
| Total Drug Medicare PaymentAmount | 48.65 |
| Total Drug Medicare Standardized Payment Amount | 48.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 129 |
| Number Of Medical Services | 4653 |
| Number Of Medicare Beneficiaries With Medical Services | 2996 |
| Total Medical Submitted Charge Amount | 576285 |
| Total Medical Medicare Allowed Amount | 134728.01 |
| Total Medical Medicare Payment Amount | 106790.71 |
| Total Medical Medicare Standardized Payment Amount | 102016.03 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 234 |
| Number Of Beneficiaries Age 65 to 74 | 1190 |
| Number Of Beneficiaries Age 75 to 84 | 945 |
| Number Of Beneficiaries Age Greater 84 | 627 |
| Number Of Female Beneficiaries | 2015 |
| Number Of Male Beneficiaries | 981 |
| Number Of Non Hispanic White Beneficiaries | 2781 |
| Number Of Black or African American Beneficiaries | 115 |
| Number Of AsianPacific Islander Beneficiaries | 28 |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 49 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2742 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 254 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.4159 |