| National Provider Identifier [NPI]: | 1104833631 |
| Last Name Of The Provider | DOLZ |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1600 W WALNUT |
| Street Address 2 Of The Provider | PASSAVANT AREA HOSPITAL - LABORATORY |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 62650 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 9656 |
| Number Of Medicare Beneficiaries | 3410 |
| Total Submitted Charge Amount | 1975034 |
| Total Medicare Allowed Amount | 543992.84 |
| Total Medicare Payment Amount | 417066.92 |
| Total Medicare Standardized Payment Amount | 286521.95 |
| 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 | 15 |
| Number Of Medical Services | 9656 |
| Number Of Medicare Beneficiaries With Medical Services | 3410 |
| Total Medical Submitted Charge Amount | 1975034 |
| Total Medical Medicare Allowed Amount | 543992.84 |
| Total Medical Medicare Payment Amount | 417066.92 |
| Total Medical Medicare Standardized Payment Amount | 286521.95 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 489 |
| Number Of Beneficiaries Age 65 to 74 | 1946 |
| Number Of Beneficiaries Age 75 to 84 | 872 |
| Number Of Beneficiaries Age Greater 84 | 103 |
| Number Of Female Beneficiaries | 1902 |
| Number Of Male Beneficiaries | 1508 |
| Number Of Non Hispanic White Beneficiaries | 2877 |
| Number Of Black or African American Beneficiaries | 305 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 110 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 65 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2879 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 531 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 4 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9773 |