| National Provider Identifier [NPI]: | 1295900611 |
| Last Name Of The Provider | STATSEVYCH |
| First Name Of The Provider | VOLODYMYR |
| 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 | 25875 SCIENCE PARK DR |
| Street Address 2 Of The Provider | AC116 |
| City Of The Provider | BEACHWOOD |
| Zip Code Of The Provider | 441227304 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 100 |
| Number Of Services | 3715 |
| Number Of Medicare Beneficiaries | 2038 |
| Total Submitted Charge Amount | 981367.06 |
| Total Medicare Allowed Amount | 135640.49 |
| Total Medicare Payment Amount | 102923.69 |
| Total Medicare Standardized Payment Amount | 106588.13 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1111 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 6160.06 |
| Total Drug Medicare AllowedAmount | 394.26 |
| Total Drug Medicare PaymentAmount | 309.13 |
| Total Drug Medicare Standardized Payment Amount | 309.13 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 98 |
| Number Of Medical Services | 2604 |
| Number Of Medicare Beneficiaries With Medical Services | 2038 |
| Total Medical Submitted Charge Amount | 975207 |
| Total Medical Medicare Allowed Amount | 135246.23 |
| Total Medical Medicare Payment Amount | 102614.56 |
| Total Medical Medicare Standardized Payment Amount | 106279 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 454 |
| Number Of Beneficiaries Age 65 to 74 | 673 |
| Number Of Beneficiaries Age 75 to 84 | 555 |
| Number Of Beneficiaries Age Greater 84 | 356 |
| Number Of Female Beneficiaries | 1177 |
| Number Of Male Beneficiaries | 861 |
| Number Of Non Hispanic White Beneficiaries | 1558 |
| Number Of Black or African American Beneficiaries | 365 |
| Number Of AsianPacific Islander Beneficiaries | 27 |
| Number Of Hispanic Beneficiaries | 64 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1350 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 688 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 15 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 2.0446 |