| National Provider Identifier [NPI]: | 1558447334 |
| Last Name Of The Provider | GOERGEN |
| First Name Of The Provider | MARK |
| 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 | 411 HAMILTON BLVD |
| Street Address 2 Of The Provider | 1824 |
| City Of The Provider | PEORIA |
| Zip Code Of The Provider | 616021144 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 63 |
| Number Of Services | 4776 |
| Number Of Medicare Beneficiaries | 2923 |
| Total Submitted Charge Amount | 1702522 |
| Total Medicare Allowed Amount | 272986.56 |
| Total Medicare Payment Amount | 207717.68 |
| Total Medicare Standardized Payment Amount | 211829.78 |
| 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 | 63 |
| Number Of Medical Services | 4776 |
| Number Of Medicare Beneficiaries With Medical Services | 2923 |
| Total Medical Submitted Charge Amount | 1702522 |
| Total Medical Medicare Allowed Amount | 272986.56 |
| Total Medical Medicare Payment Amount | 207717.68 |
| Total Medical Medicare Standardized Payment Amount | 211829.78 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 605 |
| Number Of Beneficiaries Age 65 to 74 | 1136 |
| Number Of Beneficiaries Age 75 to 84 | 840 |
| Number Of Beneficiaries Age Greater 84 | 342 |
| Number Of Female Beneficiaries | 1482 |
| Number Of Male Beneficiaries | 1441 |
| Number Of Non Hispanic White Beneficiaries | 2650 |
| Number Of Black or African American Beneficiaries | 198 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 37 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2235 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 688 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 28 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.833 |