| National Provider Identifier [NPI]: | 1336196534 |
| Last Name Of The Provider | BUTERAKOS |
| First Name Of The Provider | COSTA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 840 OAKWOOD BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | DEARBORN |
| Zip Code Of The Provider | 481242319 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 142 |
| Number Of Services | 6635 |
| Number Of Medicare Beneficiaries | 4601 |
| Total Submitted Charge Amount | 411603 |
| Total Medicare Allowed Amount | 153909.13 |
| Total Medicare Payment Amount | 118863.28 |
| Total Medicare Standardized Payment Amount | 117779.92 |
| 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 | 142 |
| Number Of Medical Services | 6635 |
| Number Of Medicare Beneficiaries With Medical Services | 4601 |
| Total Medical Submitted Charge Amount | 411603 |
| Total Medical Medicare Allowed Amount | 153909.13 |
| Total Medical Medicare Payment Amount | 118863.28 |
| Total Medical Medicare Standardized Payment Amount | 117779.92 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 1148 |
| Number Of Beneficiaries Age 65 to 74 | 1518 |
| Number Of Beneficiaries Age 75 to 84 | 1171 |
| Number Of Beneficiaries Age Greater 84 | 764 |
| Number Of Female Beneficiaries | 2876 |
| Number Of Male Beneficiaries | 1725 |
| Number Of Non Hispanic White Beneficiaries | 3717 |
| Number Of Black or African American Beneficiaries | 598 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 155 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 65 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3080 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1521 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 46 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 46 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 62 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.1064 |