| National Provider Identifier [NPI]: | 1023169745 |
| Last Name Of The Provider | FORMAN |
| First Name Of The Provider | HOWARD |
| Middle Initial Of The Provider | I |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1086 FRANKLIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | JOHNSTOWN |
| Zip Code Of The Provider | 159054305 |
| 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 | 124 |
| Number Of Services | 1852 |
| Number Of Medicare Beneficiaries | 1229 |
| Total Submitted Charge Amount | 209918 |
| Total Medicare Allowed Amount | 73674.2 |
| Total Medicare Payment Amount | 56128.4 |
| Total Medicare Standardized Payment Amount | 58760.78 |
| 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 | 124 |
| Number Of Medical Services | 1852 |
| Number Of Medicare Beneficiaries With Medical Services | 1229 |
| Total Medical Submitted Charge Amount | 209918 |
| Total Medical Medicare Allowed Amount | 73674.2 |
| Total Medical Medicare Payment Amount | 56128.4 |
| Total Medical Medicare Standardized Payment Amount | 58760.78 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 376 |
| Number Of Beneficiaries Age 65 to 74 | 390 |
| Number Of Beneficiaries Age 75 to 84 | 272 |
| Number Of Beneficiaries Age Greater 84 | 191 |
| Number Of Female Beneficiaries | 687 |
| Number Of Male Beneficiaries | 542 |
| Number Of Non Hispanic White Beneficiaries | 1162 |
| Number Of Black or African American Beneficiaries | 41 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 732 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 497 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.8535 |