| National Provider Identifier [NPI]: | 1710951579 |
| Last Name Of The Provider | TICE |
| First Name Of The Provider | JOSHUA |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | PENN STATE M.S. HERSHEY, MED CENTER, DEPT RAD., H066 |
| Street Address 2 Of The Provider | 500 UNIVERSITY DR |
| City Of The Provider | HERSHEY |
| Zip Code Of The Provider | 17033 |
| 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 | 170 |
| Number Of Services | 3606 |
| Number Of Medicare Beneficiaries | 2426 |
| Total Submitted Charge Amount | 363284 |
| Total Medicare Allowed Amount | 114207.62 |
| Total Medicare Payment Amount | 89436.79 |
| Total Medicare Standardized Payment Amount | 93521.86 |
| 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 | 170 |
| Number Of Medical Services | 3606 |
| Number Of Medicare Beneficiaries With Medical Services | 2426 |
| Total Medical Submitted Charge Amount | 363284 |
| Total Medical Medicare Allowed Amount | 114207.62 |
| Total Medical Medicare Payment Amount | 89436.79 |
| Total Medical Medicare Standardized Payment Amount | 93521.86 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 417 |
| Number Of Beneficiaries Age 65 to 74 | 788 |
| Number Of Beneficiaries Age 75 to 84 | 743 |
| Number Of Beneficiaries Age Greater 84 | 478 |
| Number Of Female Beneficiaries | 1488 |
| Number Of Male Beneficiaries | 938 |
| Number Of Non Hispanic White Beneficiaries | 2129 |
| Number Of Black or African American Beneficiaries | 80 |
| Number Of AsianPacific Islander Beneficiaries | 16 |
| Number Of Hispanic Beneficiaries | 181 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1935 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 491 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 18 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.6839 |