| National Provider Identifier [NPI]: | 1942317839 |
| Last Name Of The Provider | KMIECIK |
| First Name Of The Provider | JOSEPH |
| 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 | 626 BETHANY ROAD |
| Street Address 2 Of The Provider | |
| City Of The Provider | DEKALB |
| Zip Code Of The Provider | 601154929 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 194 |
| Number Of Services | 8665 |
| Number Of Medicare Beneficiaries | 2695 |
| Total Submitted Charge Amount | 1118797.28 |
| Total Medicare Allowed Amount | 246712.48 |
| Total Medicare Payment Amount | 196728.4 |
| Total Medicare Standardized Payment Amount | 191200.8 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 4344 |
| Number Of Medicare Beneficiaries With Drug Services | 99 |
| Total Drug Submitted ChargeAmount | 11702.84 |
| Total Drug Medicare AllowedAmount | 2791.88 |
| Total Drug Medicare PaymentAmount | 1973.39 |
| Total Drug Medicare Standardized Payment Amount | 1973.39 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 191 |
| Number Of Medical Services | 4321 |
| Number Of Medicare Beneficiaries With Medical Services | 2695 |
| Total Medical Submitted Charge Amount | 1107094.44 |
| Total Medical Medicare Allowed Amount | 243920.6 |
| Total Medical Medicare Payment Amount | 194755.01 |
| Total Medical Medicare Standardized Payment Amount | 189227.41 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 432 |
| Number Of Beneficiaries Age 65 to 74 | 1134 |
| Number Of Beneficiaries Age 75 to 84 | 714 |
| Number Of Beneficiaries Age Greater 84 | 415 |
| Number Of Female Beneficiaries | 1781 |
| Number Of Male Beneficiaries | 914 |
| Number Of Non Hispanic White Beneficiaries | 2318 |
| Number Of Black or African American Beneficiaries | 127 |
| Number Of AsianPacific Islander Beneficiaries | 31 |
| Number Of Hispanic Beneficiaries | 194 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2074 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 621 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4702 |