| National Provider Identifier [NPI]: | 1710143011 |
| Last Name Of The Provider | GENOV |
| First Name Of The Provider | IGOR |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 711 TROY SCHENECTADY RD |
| Street Address 2 Of The Provider | SUITE 201 |
| City Of The Provider | LATHAM |
| Zip Code Of The Provider | 121102442 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 254 |
| Number Of Services | 6472 |
| Number Of Medicare Beneficiaries | 3344 |
| Total Submitted Charge Amount | 1338982 |
| Total Medicare Allowed Amount | 215458.35 |
| Total Medicare Payment Amount | 159816.79 |
| Total Medicare Standardized Payment Amount | 152650.56 |
| 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 | 254 |
| Number Of Medical Services | 6472 |
| Number Of Medicare Beneficiaries With Medical Services | 3344 |
| Total Medical Submitted Charge Amount | 1338982 |
| Total Medical Medicare Allowed Amount | 215458.35 |
| Total Medical Medicare Payment Amount | 159816.79 |
| Total Medical Medicare Standardized Payment Amount | 152650.56 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 794 |
| Number Of Beneficiaries Age 65 to 74 | 948 |
| Number Of Beneficiaries Age 75 to 84 | 960 |
| Number Of Beneficiaries Age Greater 84 | 642 |
| Number Of Female Beneficiaries | 1784 |
| Number Of Male Beneficiaries | 1560 |
| Number Of Non Hispanic White Beneficiaries | 2504 |
| Number Of Black or African American Beneficiaries | 583 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 190 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 40 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2117 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1227 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 28 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 69 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 54 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 19 |
| Average HCC Risk Score Of Beneficiaries | 2.1865 |