| National Provider Identifier [NPI]: | 1942281076 |
| Last Name Of The Provider | GROSSNICKLE |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 770 PINE ST STE 290 |
| Street Address 2 Of The Provider | ATTN: RADIOLOGY DEPARTMENT |
| City Of The Provider | MACON |
| Zip Code Of The Provider | 312017516 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 165 |
| Number Of Services | 4485 |
| Number Of Medicare Beneficiaries | 2856 |
| Total Submitted Charge Amount | 616253 |
| Total Medicare Allowed Amount | 146722.35 |
| Total Medicare Payment Amount | 111184.16 |
| Total Medicare Standardized Payment Amount | 117282.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 336 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 4939 |
| Total Drug Medicare AllowedAmount | 505.09 |
| Total Drug Medicare PaymentAmount | 382.12 |
| Total Drug Medicare Standardized Payment Amount | 382.12 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 161 |
| Number Of Medical Services | 4149 |
| Number Of Medicare Beneficiaries With Medical Services | 2855 |
| Total Medical Submitted Charge Amount | 611314 |
| Total Medical Medicare Allowed Amount | 146217.26 |
| Total Medical Medicare Payment Amount | 110802.04 |
| Total Medical Medicare Standardized Payment Amount | 116900.43 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 630 |
| Number Of Beneficiaries Age 65 to 74 | 1032 |
| Number Of Beneficiaries Age 75 to 84 | 829 |
| Number Of Beneficiaries Age Greater 84 | 365 |
| Number Of Female Beneficiaries | 1728 |
| Number Of Male Beneficiaries | 1128 |
| Number Of Non Hispanic White Beneficiaries | 2033 |
| Number Of Black or African American Beneficiaries | 787 |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1993 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 863 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 1.8809 |