| National Provider Identifier [NPI]: | 1790782894 |
| Last Name Of The Provider | KULOSZEWSKI |
| First Name Of The Provider | GINA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 327 N WASHINGTON AVE |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | SCRANTON |
| Zip Code Of The Provider | 185031549 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 4045 |
| Number Of Medicare Beneficiaries | 1136 |
| Total Submitted Charge Amount | 323466 |
| Total Medicare Allowed Amount | 187406.17 |
| Total Medicare Payment Amount | 130195.22 |
| Total Medicare Standardized Payment Amount | 162485.05 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 115 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 236 |
| Total Drug Medicare AllowedAmount | 203.64 |
| Total Drug Medicare PaymentAmount | 134.64 |
| Total Drug Medicare Standardized Payment Amount | 134.64 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 3930 |
| Number Of Medicare Beneficiaries With Medical Services | 1136 |
| Total Medical Submitted Charge Amount | 323230 |
| Total Medical Medicare Allowed Amount | 187202.53 |
| Total Medical Medicare Payment Amount | 130060.58 |
| Total Medical Medicare Standardized Payment Amount | 162350.41 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 122 |
| Number Of Beneficiaries Age 65 to 74 | 526 |
| Number Of Beneficiaries Age 75 to 84 | 343 |
| Number Of Beneficiaries Age Greater 84 | 145 |
| Number Of Female Beneficiaries | 661 |
| Number Of Male Beneficiaries | 475 |
| Number Of Non Hispanic White Beneficiaries | 1103 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 982 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 154 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0128 |