| National Provider Identifier [NPI]: | 1356454540 |
| Last Name Of The Provider | GLICK |
| First Name Of The Provider | CRAIG |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 65 W JIMMIE LEEDS RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | POMONA |
| Zip Code Of The Provider | 082409102 |
| State Code Of The Provider | NJ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 175 |
| Number Of Services | 10087 |
| Number Of Medicare Beneficiaries | 4452 |
| Total Submitted Charge Amount | 1209767 |
| Total Medicare Allowed Amount | 258969.12 |
| Total Medicare Payment Amount | 190080.45 |
| Total Medicare Standardized Payment Amount | 180157.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 3066 |
| Number Of Medicare Beneficiaries With Drug Services | 36 |
| Total Drug Submitted ChargeAmount | 9318 |
| Total Drug Medicare AllowedAmount | 773.4 |
| Total Drug Medicare PaymentAmount | 606.34 |
| Total Drug Medicare Standardized Payment Amount | 606.34 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 173 |
| Number Of Medical Services | 7021 |
| Number Of Medicare Beneficiaries With Medical Services | 4452 |
| Total Medical Submitted Charge Amount | 1200449 |
| Total Medical Medicare Allowed Amount | 258195.72 |
| Total Medical Medicare Payment Amount | 189474.11 |
| Total Medical Medicare Standardized Payment Amount | 179551.28 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 735 |
| Number Of Beneficiaries Age 65 to 74 | 1639 |
| Number Of Beneficiaries Age 75 to 84 | 1331 |
| Number Of Beneficiaries Age Greater 84 | 747 |
| Number Of Female Beneficiaries | 2524 |
| Number Of Male Beneficiaries | 1928 |
| Number Of Non Hispanic White Beneficiaries | 3361 |
| Number Of Black or African American Beneficiaries | 632 |
| Number Of AsianPacific Islander Beneficiaries | 104 |
| Number Of Hispanic Beneficiaries | 308 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 47 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3471 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 981 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 50 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.794 |