| National Provider Identifier [NPI]: | 1639121767 |
| Last Name Of The Provider | HISKES |
| First Name Of The Provider | STEPHANIE |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2020 59TH STREET WEST |
| Street Address 2 Of The Provider | BLAKE MEDICAL CENTER |
| City Of The Provider | BRADENTON |
| Zip Code Of The Provider | 34209 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 200 |
| Number Of Services | 5480 |
| Number Of Medicare Beneficiaries | 2715 |
| Total Submitted Charge Amount | 526657 |
| Total Medicare Allowed Amount | 165380.59 |
| Total Medicare Payment Amount | 129990.85 |
| Total Medicare Standardized Payment Amount | 130558.66 |
| 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 | 200 |
| Number Of Medical Services | 5480 |
| Number Of Medicare Beneficiaries With Medical Services | 2715 |
| Total Medical Submitted Charge Amount | 526657 |
| Total Medical Medicare Allowed Amount | 165380.59 |
| Total Medical Medicare Payment Amount | 129990.85 |
| Total Medical Medicare Standardized Payment Amount | 130558.66 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 239 |
| Number Of Beneficiaries Age 65 to 74 | 805 |
| Number Of Beneficiaries Age 75 to 84 | 956 |
| Number Of Beneficiaries Age Greater 84 | 715 |
| Number Of Female Beneficiaries | 1660 |
| Number Of Male Beneficiaries | 1055 |
| Number Of Non Hispanic White Beneficiaries | 2521 |
| Number Of Black or African American Beneficiaries | 92 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 64 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 26 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2275 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 440 |
| Percent Of With Atrial Fibrillation | 28 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 34 |
| Percent Of With Chronic Kidney Disease | 39 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 63 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.7288 |