| National Provider Identifier [NPI]: | 1528018751 |
| Last Name Of The Provider | MIECKOWSKI |
| First Name Of The Provider | GREGORY |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 809 TURNPIKE AVE |
| Street Address 2 Of The Provider | IMAGING DEPARTMENT |
| City Of The Provider | CLEARFIELD |
| Zip Code Of The Provider | 168301232 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 188 |
| Number Of Services | 6338 |
| Number Of Medicare Beneficiaries | 3139 |
| Total Submitted Charge Amount | 555902 |
| Total Medicare Allowed Amount | 200573.95 |
| Total Medicare Payment Amount | 147256.02 |
| Total Medicare Standardized Payment Amount | 153155.74 |
| 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 | 188 |
| Number Of Medical Services | 6338 |
| Number Of Medicare Beneficiaries With Medical Services | 3139 |
| Total Medical Submitted Charge Amount | 555902 |
| Total Medical Medicare Allowed Amount | 200573.95 |
| Total Medical Medicare Payment Amount | 147256.02 |
| Total Medical Medicare Standardized Payment Amount | 153155.74 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 618 |
| Number Of Beneficiaries Age 65 to 74 | 1056 |
| Number Of Beneficiaries Age 75 to 84 | 924 |
| Number Of Beneficiaries Age Greater 84 | 541 |
| Number Of Female Beneficiaries | 2127 |
| Number Of Male Beneficiaries | 1012 |
| Number Of Non Hispanic White Beneficiaries | 3087 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2222 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 917 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3976 |