| National Provider Identifier [NPI]: | 1568457794 |
| Last Name Of The Provider | SCHULTZ |
| First Name Of The Provider | KARL |
| Middle Initial Of The Provider | W |
| 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 | SUITE 100 |
| 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 | 148 |
| Number Of Services | 4537 |
| Number Of Medicare Beneficiaries | 2534 |
| Total Submitted Charge Amount | 668626.51 |
| Total Medicare Allowed Amount | 159510.42 |
| Total Medicare Payment Amount | 114512.18 |
| Total Medicare Standardized Payment Amount | 121801.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 657 |
| Number Of Medicare Beneficiaries With Drug Services | 47 |
| Total Drug Submitted ChargeAmount | 1433.47 |
| Total Drug Medicare AllowedAmount | 1424.83 |
| Total Drug Medicare PaymentAmount | 1117.03 |
| Total Drug Medicare Standardized Payment Amount | 1117.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 144 |
| Number Of Medical Services | 3880 |
| Number Of Medicare Beneficiaries With Medical Services | 2534 |
| Total Medical Submitted Charge Amount | 667193.04 |
| Total Medical Medicare Allowed Amount | 158085.59 |
| Total Medical Medicare Payment Amount | 113395.15 |
| Total Medical Medicare Standardized Payment Amount | 120684.24 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 591 |
| Number Of Beneficiaries Age 65 to 74 | 803 |
| Number Of Beneficiaries Age 75 to 84 | 719 |
| Number Of Beneficiaries Age Greater 84 | 421 |
| Number Of Female Beneficiaries | 1457 |
| Number Of Male Beneficiaries | 1077 |
| Number Of Non Hispanic White Beneficiaries | 2213 |
| Number Of Black or African American Beneficiaries | 214 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 62 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 33 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1733 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 801 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.6658 |