| National Provider Identifier [NPI]: | 1043265952 |
| Last Name Of The Provider | KRIVISKY |
| First Name Of The Provider | BRIAN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3680 BROADWAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT MYERS |
| Zip Code Of The Provider | 339018005 |
| 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 | 225 |
| Number Of Services | 25829 |
| Number Of Medicare Beneficiaries | 4022 |
| Total Submitted Charge Amount | 1990522.77 |
| Total Medicare Allowed Amount | 528202 |
| Total Medicare Payment Amount | 407671.32 |
| Total Medicare Standardized Payment Amount | 396039.49 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 20058 |
| Number Of Medicare Beneficiaries With Drug Services | 224 |
| Total Drug Submitted ChargeAmount | 25936.12 |
| Total Drug Medicare AllowedAmount | 4028.98 |
| Total Drug Medicare PaymentAmount | 3142.17 |
| Total Drug Medicare Standardized Payment Amount | 3142.17 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 221 |
| Number Of Medical Services | 5771 |
| Number Of Medicare Beneficiaries With Medical Services | 4022 |
| Total Medical Submitted Charge Amount | 1964586.65 |
| Total Medical Medicare Allowed Amount | 524173.02 |
| Total Medical Medicare Payment Amount | 404529.15 |
| Total Medical Medicare Standardized Payment Amount | 392897.32 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 470 |
| Number Of Beneficiaries Age 65 to 74 | 1628 |
| Number Of Beneficiaries Age 75 to 84 | 1343 |
| Number Of Beneficiaries Age Greater 84 | 581 |
| Number Of Female Beneficiaries | 2131 |
| Number Of Male Beneficiaries | 1891 |
| Number Of Non Hispanic White Beneficiaries | 3467 |
| Number Of Black or African American Beneficiaries | 170 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 311 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 43 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3323 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 699 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.7201 |