| National Provider Identifier [NPI]: | 1265643332 |
| Last Name Of The Provider | BACCHUS |
| First Name Of The Provider | LEON |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5501 OLD YORK RD |
| Street Address 2 Of The Provider | DEPARTMENT OF MEDICINE |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191413018 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 69 |
| Number Of Services | 5464 |
| Number Of Medicare Beneficiaries | 3772 |
| Total Submitted Charge Amount | 708843.46 |
| Total Medicare Allowed Amount | 152576.59 |
| Total Medicare Payment Amount | 115906.71 |
| Total Medicare Standardized Payment Amount | 104213.12 |
| 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 | 69 |
| Number Of Medical Services | 5464 |
| Number Of Medicare Beneficiaries With Medical Services | 3772 |
| Total Medical Submitted Charge Amount | 708843.46 |
| Total Medical Medicare Allowed Amount | 152576.59 |
| Total Medical Medicare Payment Amount | 115906.71 |
| Total Medical Medicare Standardized Payment Amount | 104213.12 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 382 |
| Number Of Beneficiaries Age 65 to 74 | 1161 |
| Number Of Beneficiaries Age 75 to 84 | 1207 |
| Number Of Beneficiaries Age Greater 84 | 1022 |
| Number Of Female Beneficiaries | 2064 |
| Number Of Male Beneficiaries | 1708 |
| Number Of Non Hispanic White Beneficiaries | 2898 |
| Number Of Black or African American Beneficiaries | 417 |
| Number Of AsianPacific Islander Beneficiaries | 183 |
| Number Of Hispanic Beneficiaries | 170 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2909 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 863 |
| Percent Of With Atrial Fibrillation | 29 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 26 |
| Percent Of With Heart Failure | 47 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 73 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 73 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.2546 |