| National Provider Identifier [NPI]: | 1316983133 |
| Last Name Of The Provider | KOSTRUBIAK |
| First Name Of The Provider | IRENE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7253 AMBASSADOR RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | BALTIMORE |
| Zip Code Of The Provider | 212442710 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 139 |
| Number Of Services | 17792 |
| Number Of Medicare Beneficiaries | 3711 |
| Total Submitted Charge Amount | 1205820.61 |
| Total Medicare Allowed Amount | 476292.25 |
| Total Medicare Payment Amount | 372230.77 |
| Total Medicare Standardized Payment Amount | 350777.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 11480 |
| Number Of Medicare Beneficiaries With Drug Services | 110 |
| Total Drug Submitted ChargeAmount | 2640.4 |
| Total Drug Medicare AllowedAmount | 2077.16 |
| Total Drug Medicare PaymentAmount | 1488.9 |
| Total Drug Medicare Standardized Payment Amount | 1488.9 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 138 |
| Number Of Medical Services | 6312 |
| Number Of Medicare Beneficiaries With Medical Services | 3711 |
| Total Medical Submitted Charge Amount | 1203180.21 |
| Total Medical Medicare Allowed Amount | 474215.09 |
| Total Medical Medicare Payment Amount | 370741.87 |
| Total Medical Medicare Standardized Payment Amount | 349288.92 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 635 |
| Number Of Beneficiaries Age 65 to 74 | 1454 |
| Number Of Beneficiaries Age 75 to 84 | 1052 |
| Number Of Beneficiaries Age Greater 84 | 570 |
| Number Of Female Beneficiaries | 2666 |
| Number Of Male Beneficiaries | 1045 |
| Number Of Non Hispanic White Beneficiaries | 3102 |
| Number Of Black or African American Beneficiaries | 507 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 48 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 29 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3026 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 685 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.6121 |