| National Provider Identifier [NPI]: | 1669449625 |
| Last Name Of The Provider | VLASIC |
| First Name Of The Provider | NIKSA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 901 LAKESHORE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | ISHPEMING |
| Zip Code Of The Provider | 498491367 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 225 |
| Number Of Services | 5988 |
| Number Of Medicare Beneficiaries | 2984 |
| Total Submitted Charge Amount | 775165 |
| Total Medicare Allowed Amount | 161828.17 |
| Total Medicare Payment Amount | 123465.94 |
| Total Medicare Standardized Payment Amount | 127626.33 |
| 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 | 225 |
| Number Of Medical Services | 5988 |
| Number Of Medicare Beneficiaries With Medical Services | 2984 |
| Total Medical Submitted Charge Amount | 775165 |
| Total Medical Medicare Allowed Amount | 161828.17 |
| Total Medical Medicare Payment Amount | 123465.94 |
| Total Medical Medicare Standardized Payment Amount | 127626.33 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 562 |
| Number Of Beneficiaries Age 65 to 74 | 1176 |
| Number Of Beneficiaries Age 75 to 84 | 844 |
| Number Of Beneficiaries Age Greater 84 | 402 |
| Number Of Female Beneficiaries | 1874 |
| Number Of Male Beneficiaries | 1110 |
| Number Of Non Hispanic White Beneficiaries | 2820 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 131 |
| Number Of Beneficiaries With Race Not Else where Classified | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2332 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 652 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0977 |