| National Provider Identifier [NPI]: | 1417902115 |
| Last Name Of The Provider | PACIS |
| First Name Of The Provider | ANDRESITO |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8615 QUEENS BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | ELMHURST |
| Zip Code Of The Provider | 113734427 |
| 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 | 88 |
| Number Of Services | 3164 |
| Number Of Medicare Beneficiaries | 1562 |
| Total Submitted Charge Amount | 395144.73 |
| Total Medicare Allowed Amount | 225233.31 |
| Total Medicare Payment Amount | 185969.61 |
| Total Medicare Standardized Payment Amount | 163306.66 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
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| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 219 |
| Number Of Beneficiaries Age 65 to 74 | 793 |
| Number Of Beneficiaries Age 75 to 84 | 420 |
| Number Of Beneficiaries Age Greater 84 | 130 |
| Number Of Female Beneficiaries | 1139 |
| Number Of Male Beneficiaries | 423 |
| Number Of Non Hispanic White Beneficiaries | 385 |
| Number Of Black or African American Beneficiaries | 483 |
| Number Of AsianPacific Islander Beneficiaries | 209 |
| Number Of Hispanic Beneficiaries | 406 |
| Number Of American Indian Alaska Native Beneficiaries | 11 |
| Number Of Beneficiaries With Race Not Else where Classified | 68 |
| Number Of Beneficiaries With Medicare Only Entitlement | 861 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 701 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1332 |