| National Provider Identifier [NPI]: | 1720100100 |
| Last Name Of The Provider | KODSI |
| First Name Of The Provider | SAMIR |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1086 FRANKLIN ST |
| Street Address 2 Of The Provider | RADIOLOGY DEPT |
| City Of The Provider | JOHNSTOWN |
| Zip Code Of The Provider | 159054305 |
| 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 | 149 |
| Number Of Services | 3982 |
| Number Of Medicare Beneficiaries | 2170 |
| Total Submitted Charge Amount | 313041 |
| Total Medicare Allowed Amount | 108530.18 |
| Total Medicare Payment Amount | 83678.17 |
| Total Medicare Standardized Payment Amount | 87008.34 |
| 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 | 149 |
| Number Of Medical Services | 3982 |
| Number Of Medicare Beneficiaries With Medical Services | 2170 |
| Total Medical Submitted Charge Amount | 313041 |
| Total Medical Medicare Allowed Amount | 108530.18 |
| Total Medical Medicare Payment Amount | 83678.17 |
| Total Medical Medicare Standardized Payment Amount | 87008.34 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 601 |
| Number Of Beneficiaries Age 65 to 74 | 672 |
| Number Of Beneficiaries Age 75 to 84 | 507 |
| Number Of Beneficiaries Age Greater 84 | 390 |
| Number Of Female Beneficiaries | 1334 |
| Number Of Male Beneficiaries | 836 |
| Number Of Non Hispanic White Beneficiaries | 2072 |
| Number Of Black or African American Beneficiaries | 71 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1311 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 859 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.8188 |