| National Provider Identifier [NPI]: | 1639159601 |
| Last Name Of The Provider | OLSON |
| First Name Of The Provider | ELDON |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 620 W EDISON RD |
| Street Address 2 Of The Provider | STE 110 |
| City Of The Provider | MISHAWAKA |
| Zip Code Of The Provider | 465452784 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 134 |
| Number Of Services | 4124 |
| Number Of Medicare Beneficiaries | 2948 |
| Total Submitted Charge Amount | 587279.95 |
| Total Medicare Allowed Amount | 116849.21 |
| Total Medicare Payment Amount | 82524.91 |
| Total Medicare Standardized Payment Amount | 87446.07 |
| 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 | 134 |
| Number Of Medical Services | 4124 |
| Number Of Medicare Beneficiaries With Medical Services | 2948 |
| Total Medical Submitted Charge Amount | 587279.95 |
| Total Medical Medicare Allowed Amount | 116849.21 |
| Total Medical Medicare Payment Amount | 82524.91 |
| Total Medical Medicare Standardized Payment Amount | 87446.07 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 602 |
| Number Of Beneficiaries Age 65 to 74 | 898 |
| Number Of Beneficiaries Age 75 to 84 | 852 |
| Number Of Beneficiaries Age Greater 84 | 596 |
| Number Of Female Beneficiaries | 1654 |
| Number Of Male Beneficiaries | 1294 |
| Number Of Non Hispanic White Beneficiaries | 2613 |
| Number Of Black or African American Beneficiaries | 226 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 63 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 32 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2071 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 877 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.6765 |