| National Provider Identifier [NPI]: | 1003807181 |
| Last Name Of The Provider | CZERVIONKE |
| First Name Of The Provider | LEO |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4500 SAN PABLO RD S |
| Street Address 2 Of The Provider | |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322241865 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 66 |
| Number Of Services | 20356 |
| Number Of Medicare Beneficiaries | 1385 |
| Total Submitted Charge Amount | 470624.29 |
| Total Medicare Allowed Amount | 302624.81 |
| Total Medicare Payment Amount | 226673.97 |
| Total Medicare Standardized Payment Amount | 257401.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 18505 |
| Number Of Medicare Beneficiaries With Drug Services | 405 |
| Total Drug Submitted ChargeAmount | 14050.38 |
| Total Drug Medicare AllowedAmount | 11032.58 |
| Total Drug Medicare PaymentAmount | 7727.27 |
| Total Drug Medicare Standardized Payment Amount | 7727.27 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 58 |
| Number Of Medical Services | 1851 |
| Number Of Medicare Beneficiaries With Medical Services | 1348 |
| Total Medical Submitted Charge Amount | 456573.91 |
| Total Medical Medicare Allowed Amount | 291592.23 |
| Total Medical Medicare Payment Amount | 218946.7 |
| Total Medical Medicare Standardized Payment Amount | 249674.29 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 183 |
| Number Of Beneficiaries Age 65 to 74 | 500 |
| Number Of Beneficiaries Age 75 to 84 | 479 |
| Number Of Beneficiaries Age Greater 84 | 223 |
| Number Of Female Beneficiaries | 761 |
| Number Of Male Beneficiaries | 624 |
| Number Of Non Hispanic White Beneficiaries | 1221 |
| Number Of Black or African American Beneficiaries | 85 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 41 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1286 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 99 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 51 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 1.5547 |