| National Provider Identifier [NPI]: | 1295708212 |
| Last Name Of The Provider | VICIK |
| First Name Of The Provider | GARY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3608 W MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | BELLEVILLE |
| Zip Code Of The Provider | 622266225 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 87 |
| Number Of Services | 10246 |
| Number Of Medicare Beneficiaries | 1498 |
| Total Submitted Charge Amount | 830848 |
| Total Medicare Allowed Amount | 533771.43 |
| Total Medicare Payment Amount | 381242.25 |
| Total Medicare Standardized Payment Amount | 376594.95 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 62 |
| Number Of Medicare Beneficiaries With Drug Services | 41 |
| Total Drug Submitted ChargeAmount | 5752 |
| Total Drug Medicare AllowedAmount | 4521.04 |
| Total Drug Medicare PaymentAmount | 3499.84 |
| Total Drug Medicare Standardized Payment Amount | 3499.84 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 85 |
| Number Of Medical Services | 10184 |
| Number Of Medicare Beneficiaries With Medical Services | 1498 |
| Total Medical Submitted Charge Amount | 825096 |
| Total Medical Medicare Allowed Amount | 529250.39 |
| Total Medical Medicare Payment Amount | 377742.41 |
| Total Medical Medicare Standardized Payment Amount | 373095.11 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 147 |
| Number Of Beneficiaries Age 65 to 74 | 610 |
| Number Of Beneficiaries Age 75 to 84 | 503 |
| Number Of Beneficiaries Age Greater 84 | 238 |
| Number Of Female Beneficiaries | 714 |
| Number Of Male Beneficiaries | 784 |
| Number Of Non Hispanic White Beneficiaries | 1334 |
| Number Of Black or African American Beneficiaries | 129 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1301 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 197 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1109 |