| National Provider Identifier [NPI]: | 1518046390 |
| Last Name Of The Provider | DIXON |
| First Name Of The Provider | GERALD |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 401 SW WATER ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | PEORIA |
| Zip Code Of The Provider | 616021571 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 142 |
| Number Of Services | 6601 |
| Number Of Medicare Beneficiaries | 4908 |
| Total Submitted Charge Amount | 747434 |
| Total Medicare Allowed Amount | 131603.48 |
| Total Medicare Payment Amount | 96919.65 |
| Total Medicare Standardized Payment Amount | 98737.2 |
| 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 | 6601 |
| Number Of Medicare Beneficiaries With Medical Services | 4908 |
| Total Medical Submitted Charge Amount | 747434 |
| Total Medical Medicare Allowed Amount | 131603.48 |
| Total Medical Medicare Payment Amount | 96919.65 |
| Total Medical Medicare Standardized Payment Amount | 98737.2 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 922 |
| Number Of Beneficiaries Age 65 to 74 | 1825 |
| Number Of Beneficiaries Age 75 to 84 | 1386 |
| Number Of Beneficiaries Age Greater 84 | 775 |
| Number Of Female Beneficiaries | 2818 |
| Number Of Male Beneficiaries | 2090 |
| Number Of Non Hispanic White Beneficiaries | 4500 |
| Number Of Black or African American Beneficiaries | 258 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 77 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 49 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3704 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1204 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 29 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5935 |