| National Provider Identifier [NPI]: | 1457399057 |
| Last Name Of The Provider | DOLAR |
| First Name Of The Provider | MARIATHEA |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1701 N SENATE BLVD |
| Street Address 2 Of The Provider | ROOM 1204A |
| City Of The Provider | INDIANAPOLIS |
| Zip Code Of The Provider | 462021239 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 1280 |
| Number Of Medicare Beneficiaries | 1062 |
| Total Submitted Charge Amount | 232192 |
| Total Medicare Allowed Amount | 74755.39 |
| Total Medicare Payment Amount | 55796.36 |
| Total Medicare Standardized Payment Amount | 59285.61 |
| 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 | 40 |
| Number Of Medical Services | 1280 |
| Number Of Medicare Beneficiaries With Medical Services | 1062 |
| Total Medical Submitted Charge Amount | 232192 |
| Total Medical Medicare Allowed Amount | 74755.39 |
| Total Medical Medicare Payment Amount | 55796.36 |
| Total Medical Medicare Standardized Payment Amount | 59285.61 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 331 |
| Number Of Beneficiaries Age 65 to 74 | 322 |
| Number Of Beneficiaries Age 75 to 84 | 265 |
| Number Of Beneficiaries Age Greater 84 | 144 |
| Number Of Female Beneficiaries | 611 |
| Number Of Male Beneficiaries | 451 |
| Number Of Non Hispanic White Beneficiaries | 813 |
| Number Of Black or African American Beneficiaries | 215 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 607 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 455 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 21 |
| Average HCC Risk Score Of Beneficiaries | 1.9981 |