| National Provider Identifier [NPI]: | 1992770986 |
| Last Name Of The Provider | LYDDON |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 24681 NORTHWESTERN HWY |
| Street Address 2 Of The Provider | STE 300 |
| City Of The Provider | SOUTHFIELD |
| Zip Code Of The Provider | 480752305 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 128 |
| Number Of Services | 12851 |
| Number Of Medicare Beneficiaries | 2951 |
| Total Submitted Charge Amount | 1406928.7 |
| Total Medicare Allowed Amount | 693543.86 |
| Total Medicare Payment Amount | 555313.2 |
| Total Medicare Standardized Payment Amount | 555050.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 8020 |
| Number Of Medicare Beneficiaries With Drug Services | 90 |
| Total Drug Submitted ChargeAmount | 8537.9 |
| Total Drug Medicare AllowedAmount | 3098.5 |
| Total Drug Medicare PaymentAmount | 2405.89 |
| Total Drug Medicare Standardized Payment Amount | 2405.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 126 |
| Number Of Medical Services | 4831 |
| Number Of Medicare Beneficiaries With Medical Services | 2951 |
| Total Medical Submitted Charge Amount | 1398390.8 |
| Total Medical Medicare Allowed Amount | 690445.36 |
| Total Medical Medicare Payment Amount | 552907.31 |
| Total Medical Medicare Standardized Payment Amount | 552644.66 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 329 |
| Number Of Beneficiaries Age 65 to 74 | 1321 |
| Number Of Beneficiaries Age 75 to 84 | 935 |
| Number Of Beneficiaries Age Greater 84 | 366 |
| Number Of Female Beneficiaries | 2045 |
| Number Of Male Beneficiaries | 906 |
| Number Of Non Hispanic White Beneficiaries | 1840 |
| Number Of Black or African American Beneficiaries | 1020 |
| Number Of AsianPacific Islander Beneficiaries | 26 |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 45 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2605 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 346 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1399 |