| National Provider Identifier [NPI]: | 1083729222 |
| Last Name Of The Provider | HICKLIN |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9100 W 74TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SHAWNEE MISSION |
| Zip Code Of The Provider | 662044004 |
| State Code Of The Provider | KS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 162 |
| Number Of Services | 4348 |
| Number Of Medicare Beneficiaries | 2173 |
| Total Submitted Charge Amount | 540870.78 |
| Total Medicare Allowed Amount | 158025.18 |
| Total Medicare Payment Amount | 122962.48 |
| Total Medicare Standardized Payment Amount | 132165.74 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 1317 |
| Number Of Medicare Beneficiaries With Drug Services | 34 |
| Total Drug Submitted ChargeAmount | 4745 |
| Total Drug Medicare AllowedAmount | 876.21 |
| Total Drug Medicare PaymentAmount | 686.97 |
| Total Drug Medicare Standardized Payment Amount | 686.97 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 158 |
| Number Of Medical Services | 3031 |
| Number Of Medicare Beneficiaries With Medical Services | 2173 |
| Total Medical Submitted Charge Amount | 536125.78 |
| Total Medical Medicare Allowed Amount | 157148.97 |
| Total Medical Medicare Payment Amount | 122275.51 |
| Total Medical Medicare Standardized Payment Amount | 131478.77 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 312 |
| Number Of Beneficiaries Age 65 to 74 | 865 |
| Number Of Beneficiaries Age 75 to 84 | 601 |
| Number Of Beneficiaries Age Greater 84 | 395 |
| Number Of Female Beneficiaries | 1345 |
| Number Of Male Beneficiaries | 828 |
| Number Of Non Hispanic White Beneficiaries | 1957 |
| Number Of Black or African American Beneficiaries | 110 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 50 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 28 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1876 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 297 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.4773 |