| National Provider Identifier [NPI]: | 1548254089 |
| Last Name Of The Provider | KOWALCZYK |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1127 WILSHIRE BLVD |
| Street Address 2 Of The Provider | SUITE 1001 |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 900173901 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 107 |
| Number Of Services | 5250 |
| Number Of Medicare Beneficiaries | 970 |
| Total Submitted Charge Amount | 1223374.49 |
| Total Medicare Allowed Amount | 400095.57 |
| Total Medicare Payment Amount | 307792.28 |
| Total Medicare Standardized Payment Amount | 284872.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 607 |
| Number Of Medicare Beneficiaries With Drug Services | 69 |
| Total Drug Submitted ChargeAmount | 93151.95 |
| Total Drug Medicare AllowedAmount | 52368.86 |
| Total Drug Medicare PaymentAmount | 41057.53 |
| Total Drug Medicare Standardized Payment Amount | 41057.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 97 |
| Number Of Medical Services | 4643 |
| Number Of Medicare Beneficiaries With Medical Services | 970 |
| Total Medical Submitted Charge Amount | 1130222.54 |
| Total Medical Medicare Allowed Amount | 347726.71 |
| Total Medical Medicare Payment Amount | 266734.75 |
| Total Medical Medicare Standardized Payment Amount | 243814.87 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 169 |
| Number Of Beneficiaries Age 65 to 74 | 415 |
| Number Of Beneficiaries Age 75 to 84 | 257 |
| Number Of Beneficiaries Age Greater 84 | 129 |
| Number Of Female Beneficiaries | 204 |
| Number Of Male Beneficiaries | 766 |
| Number Of Non Hispanic White Beneficiaries | 336 |
| Number Of Black or African American Beneficiaries | 156 |
| Number Of AsianPacific Islander Beneficiaries | 55 |
| Number Of Hispanic Beneficiaries | 400 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 373 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 597 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.804 |