| National Provider Identifier [NPI]: | 1023055969 |
| Last Name Of The Provider | DRAKE |
| First Name Of The Provider | JERRY |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 840 OAKWOOD BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | DEARBORN |
| Zip Code Of The Provider | 481242319 |
| 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 | 190 |
| Number Of Services | 7114 |
| Number Of Medicare Beneficiaries | 4735 |
| Total Submitted Charge Amount | 609089 |
| Total Medicare Allowed Amount | 233054.39 |
| Total Medicare Payment Amount | 176906.47 |
| Total Medicare Standardized Payment Amount | 175044.25 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 57 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 4157 |
| Total Drug Medicare AllowedAmount | 2840.65 |
| Total Drug Medicare PaymentAmount | 2227.05 |
| Total Drug Medicare Standardized Payment Amount | 2227.05 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 187 |
| Number Of Medical Services | 7057 |
| Number Of Medicare Beneficiaries With Medical Services | 4735 |
| Total Medical Submitted Charge Amount | 604932 |
| Total Medical Medicare Allowed Amount | 230213.74 |
| Total Medical Medicare Payment Amount | 174679.42 |
| Total Medical Medicare Standardized Payment Amount | 172817.2 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 1189 |
| Number Of Beneficiaries Age 65 to 74 | 1403 |
| Number Of Beneficiaries Age 75 to 84 | 1270 |
| Number Of Beneficiaries Age Greater 84 | 873 |
| Number Of Female Beneficiaries | 2837 |
| Number Of Male Beneficiaries | 1898 |
| Number Of Non Hispanic White Beneficiaries | 3729 |
| Number Of Black or African American Beneficiaries | 742 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 144 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 64 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3129 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1606 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 51 |
| Percent Of With Chronic Kidney Disease | 50 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 47 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 53 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 68 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.3242 |