| National Provider Identifier [NPI]: | 1063541993 |
| Last Name Of The Provider | PETROVITCH |
| First Name Of The Provider | IVAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1701 N GEORGE MASON DR |
| Street Address 2 Of The Provider | DEPARTMENT OF RADIOLOGY |
| City Of The Provider | ARLINGTON |
| Zip Code Of The Provider | 222053610 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 138 |
| Number Of Services | 5201 |
| Number Of Medicare Beneficiaries | 3489 |
| Total Submitted Charge Amount | 886877.2 |
| Total Medicare Allowed Amount | 208624.36 |
| Total Medicare Payment Amount | 161892.07 |
| Total Medicare Standardized Payment Amount | 150992.44 |
| 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 | 138 |
| Number Of Medical Services | 5201 |
| Number Of Medicare Beneficiaries With Medical Services | 3489 |
| Total Medical Submitted Charge Amount | 886877.2 |
| Total Medical Medicare Allowed Amount | 208624.36 |
| Total Medical Medicare Payment Amount | 161892.07 |
| Total Medical Medicare Standardized Payment Amount | 150992.44 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 301 |
| Number Of Beneficiaries Age 65 to 74 | 1239 |
| Number Of Beneficiaries Age 75 to 84 | 1151 |
| Number Of Beneficiaries Age Greater 84 | 798 |
| Number Of Female Beneficiaries | 1979 |
| Number Of Male Beneficiaries | 1510 |
| Number Of Non Hispanic White Beneficiaries | 2506 |
| Number Of Black or African American Beneficiaries | 493 |
| Number Of AsianPacific Islander Beneficiaries | 161 |
| Number Of Hispanic Beneficiaries | 256 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2922 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 567 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.5722 |