| National Provider Identifier [NPI]: | 1447478524 |
| Last Name Of The Provider | SKONIECZKI |
| First Name Of The Provider | BRENDAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 593 EDDY ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PROVIDENCE |
| Zip Code Of The Provider | 029034923 |
| State Code Of The Provider | RI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 158 |
| Number Of Services | 4708 |
| Number Of Medicare Beneficiaries | 2601 |
| Total Submitted Charge Amount | 675627.3 |
| Total Medicare Allowed Amount | 152943.27 |
| Total Medicare Payment Amount | 116883.94 |
| Total Medicare Standardized Payment Amount | 123527.59 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 589 |
| Number Of Medicare Beneficiaries With Drug Services | 41 |
| Total Drug Submitted ChargeAmount | 5890 |
| Total Drug Medicare AllowedAmount | 1325.67 |
| Total Drug Medicare PaymentAmount | 971.52 |
| Total Drug Medicare Standardized Payment Amount | 971.52 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 154 |
| Number Of Medical Services | 4119 |
| Number Of Medicare Beneficiaries With Medical Services | 2600 |
| Total Medical Submitted Charge Amount | 669737.3 |
| Total Medical Medicare Allowed Amount | 151617.6 |
| Total Medical Medicare Payment Amount | 115912.42 |
| Total Medical Medicare Standardized Payment Amount | 122556.07 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 669 |
| Number Of Beneficiaries Age 65 to 74 | 889 |
| Number Of Beneficiaries Age 75 to 84 | 670 |
| Number Of Beneficiaries Age Greater 84 | 373 |
| Number Of Female Beneficiaries | 1660 |
| Number Of Male Beneficiaries | 941 |
| Number Of Non Hispanic White Beneficiaries | 2431 |
| Number Of Black or African American Beneficiaries | 79 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 34 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 37 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1748 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 853 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.5399 |