| National Provider Identifier [NPI]: | 1851548127 |
| Last Name Of The Provider | GOLEWALE |
| First Name Of The Provider | NAZAR |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 620 W EDISON RD |
| Street Address 2 Of The Provider | STE 110 |
| City Of The Provider | MISHAWAKA |
| Zip Code Of The Provider | 465452784 |
| 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 | 276 |
| Number Of Services | 3152 |
| Number Of Medicare Beneficiaries | 1828 |
| Total Submitted Charge Amount | 1187763.95 |
| Total Medicare Allowed Amount | 213431.72 |
| Total Medicare Payment Amount | 159064.34 |
| Total Medicare Standardized Payment Amount | 166651.48 |
| 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 | 276 |
| Number Of Medical Services | 3152 |
| Number Of Medicare Beneficiaries With Medical Services | 1828 |
| Total Medical Submitted Charge Amount | 1187763.95 |
| Total Medical Medicare Allowed Amount | 213431.72 |
| Total Medical Medicare Payment Amount | 159064.34 |
| Total Medical Medicare Standardized Payment Amount | 166651.48 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 391 |
| Number Of Beneficiaries Age 65 to 74 | 586 |
| Number Of Beneficiaries Age 75 to 84 | 543 |
| Number Of Beneficiaries Age Greater 84 | 308 |
| Number Of Female Beneficiaries | 977 |
| Number Of Male Beneficiaries | 851 |
| Number Of Non Hispanic White Beneficiaries | 1632 |
| Number Of Black or African American Beneficiaries | 127 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 37 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1271 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 557 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.7782 |