| National Provider Identifier [NPI]: | 1912960857 |
| Last Name Of The Provider | HOLZ |
| First Name Of The Provider | GWYNNE |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9500 EUCLID AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CLEVELAND |
| Zip Code Of The Provider | 441950001 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 118 |
| Number Of Services | 4640 |
| Number Of Medicare Beneficiaries | 2272 |
| Total Submitted Charge Amount | 709281.16 |
| Total Medicare Allowed Amount | 97461.24 |
| Total Medicare Payment Amount | 74051.65 |
| Total Medicare Standardized Payment Amount | 77322.75 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 1246 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 15525.16 |
| Total Drug Medicare AllowedAmount | 264.87 |
| Total Drug Medicare PaymentAmount | 190.82 |
| Total Drug Medicare Standardized Payment Amount | 190.82 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 117 |
| Number Of Medical Services | 3394 |
| Number Of Medicare Beneficiaries With Medical Services | 2272 |
| Total Medical Submitted Charge Amount | 693756 |
| Total Medical Medicare Allowed Amount | 97196.37 |
| Total Medical Medicare Payment Amount | 73860.83 |
| Total Medical Medicare Standardized Payment Amount | 77131.93 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 410 |
| Number Of Beneficiaries Age 65 to 74 | 874 |
| Number Of Beneficiaries Age 75 to 84 | 599 |
| Number Of Beneficiaries Age Greater 84 | 389 |
| Number Of Female Beneficiaries | 1415 |
| Number Of Male Beneficiaries | 857 |
| Number Of Non Hispanic White Beneficiaries | 1935 |
| Number Of Black or African American Beneficiaries | 234 |
| Number Of AsianPacific Islander Beneficiaries | 18 |
| Number Of Hispanic Beneficiaries | 53 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 32 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1675 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 597 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 57 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.7924 |