| National Provider Identifier [NPI]: | 1619918349 |
| Last Name Of The Provider | MA |
| First Name Of The Provider | LORALIE |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7253 AMBASSADOR RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BALTIMORE |
| Zip Code Of The Provider | 212442710 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 162 |
| Number Of Services | 12796 |
| Number Of Medicare Beneficiaries | 2582 |
| Total Submitted Charge Amount | 2658745.55 |
| Total Medicare Allowed Amount | 770936.38 |
| Total Medicare Payment Amount | 589019.09 |
| Total Medicare Standardized Payment Amount | 558970.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 9506 |
| Number Of Medicare Beneficiaries With Drug Services | 418 |
| Total Drug Submitted ChargeAmount | 18395.59 |
| Total Drug Medicare AllowedAmount | 12657.01 |
| Total Drug Medicare PaymentAmount | 9402.81 |
| Total Drug Medicare Standardized Payment Amount | 9402.81 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 157 |
| Number Of Medical Services | 3290 |
| Number Of Medicare Beneficiaries With Medical Services | 2580 |
| Total Medical Submitted Charge Amount | 2640349.96 |
| Total Medical Medicare Allowed Amount | 758279.37 |
| Total Medical Medicare Payment Amount | 579616.28 |
| Total Medical Medicare Standardized Payment Amount | 549567.77 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 387 |
| Number Of Beneficiaries Age 65 to 74 | 1161 |
| Number Of Beneficiaries Age 75 to 84 | 717 |
| Number Of Beneficiaries Age Greater 84 | 317 |
| Number Of Female Beneficiaries | 1544 |
| Number Of Male Beneficiaries | 1038 |
| Number Of Non Hispanic White Beneficiaries | 2056 |
| Number Of Black or African American Beneficiaries | 412 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 36 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 41 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2246 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 336 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.2645 |