| National Provider Identifier [NPI]: | 1710924675 |
| Last Name Of The Provider | KIESZ |
| First Name Of The Provider | RADOSLAW |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 18615 TUSCANY STONE |
| Street Address 2 Of The Provider | SUITE 170 |
| City Of The Provider | SAN ANTONIO |
| Zip Code Of The Provider | 782583489 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 84 |
| Number Of Services | 41898 |
| Number Of Medicare Beneficiaries | 356 |
| Total Submitted Charge Amount | 10492225.98 |
| Total Medicare Allowed Amount | 1228272.92 |
| Total Medicare Payment Amount | 953452.07 |
| Total Medicare Standardized Payment Amount | 1030464.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 38729 |
| Number Of Medicare Beneficiaries With Drug Services | 163 |
| Total Drug Submitted ChargeAmount | 418314.96 |
| Total Drug Medicare AllowedAmount | 77755.25 |
| Total Drug Medicare PaymentAmount | 60628.21 |
| Total Drug Medicare Standardized Payment Amount | 60628.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 80 |
| Number Of Medical Services | 3169 |
| Number Of Medicare Beneficiaries With Medical Services | 356 |
| Total Medical Submitted Charge Amount | 10073911.02 |
| Total Medical Medicare Allowed Amount | 1150517.67 |
| Total Medical Medicare Payment Amount | 892823.86 |
| Total Medical Medicare Standardized Payment Amount | 969836.6 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 177 |
| Number Of Beneficiaries Age 75 to 84 | 90 |
| Number Of Beneficiaries Age Greater 84 | 40 |
| Number Of Female Beneficiaries | 180 |
| Number Of Male Beneficiaries | 176 |
| Number Of Non Hispanic White Beneficiaries | 208 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 111 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 311 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 45 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.9647 |