| National Provider Identifier [NPI]: | 1881668440 |
| Last Name Of The Provider | PETROCHKO |
| First Name Of The Provider | CONSTANTINE |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 110 N MAIN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | GREENVILLE |
| Zip Code Of The Provider | 161251726 |
| 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 | 206 |
| Number Of Services | 4929 |
| Number Of Medicare Beneficiaries | 2503 |
| Total Submitted Charge Amount | 520226 |
| Total Medicare Allowed Amount | 137033.38 |
| Total Medicare Payment Amount | 107266.38 |
| Total Medicare Standardized Payment Amount | 110286.25 |
| 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 | 206 |
| Number Of Medical Services | 4929 |
| Number Of Medicare Beneficiaries With Medical Services | 2503 |
| Total Medical Submitted Charge Amount | 520226 |
| Total Medical Medicare Allowed Amount | 137033.38 |
| Total Medical Medicare Payment Amount | 107266.38 |
| Total Medical Medicare Standardized Payment Amount | 110286.25 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 652 |
| Number Of Beneficiaries Age 65 to 74 | 896 |
| Number Of Beneficiaries Age 75 to 84 | 604 |
| Number Of Beneficiaries Age Greater 84 | 351 |
| Number Of Female Beneficiaries | 1586 |
| Number Of Male Beneficiaries | 917 |
| Number Of Non Hispanic White Beneficiaries | 2349 |
| Number Of Black or African American Beneficiaries | 116 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1785 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 718 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.5036 |