| National Provider Identifier [NPI]: | 1932159878 |
| Last Name Of The Provider | MARTIN |
| First Name Of The Provider | JACK |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4518 UNION DEPOSIT RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | HARRISBURG |
| Zip Code Of The Provider | 171112910 |
| 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 | 137 |
| Number Of Services | 4397 |
| Number Of Medicare Beneficiaries | 2232 |
| Total Submitted Charge Amount | 819317.3 |
| Total Medicare Allowed Amount | 116042.34 |
| Total Medicare Payment Amount | 90310.43 |
| Total Medicare Standardized Payment Amount | 93699.89 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 785 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 2979.3 |
| Total Drug Medicare AllowedAmount | 299.47 |
| Total Drug Medicare PaymentAmount | 234.79 |
| Total Drug Medicare Standardized Payment Amount | 234.79 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 135 |
| Number Of Medical Services | 3612 |
| Number Of Medicare Beneficiaries With Medical Services | 2232 |
| Total Medical Submitted Charge Amount | 816338 |
| Total Medical Medicare Allowed Amount | 115742.87 |
| Total Medical Medicare Payment Amount | 90075.64 |
| Total Medical Medicare Standardized Payment Amount | 93465.1 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 572 |
| Number Of Beneficiaries Age 65 to 74 | 955 |
| Number Of Beneficiaries Age 75 to 84 | 522 |
| Number Of Beneficiaries Age Greater 84 | 183 |
| Number Of Female Beneficiaries | 1497 |
| Number Of Male Beneficiaries | 735 |
| Number Of Non Hispanic White Beneficiaries | 2130 |
| Number Of Black or African American Beneficiaries | 32 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 33 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1543 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 689 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.3708 |