| National Provider Identifier [NPI]: | 1700842275 |
| Last Name Of The Provider | KOSTELIC |
| First Name Of The Provider | JON |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1218 SOUTH BROADWAY |
| Street Address 2 Of The Provider | SUITE 310 |
| City Of The Provider | LEXINGTON |
| Zip Code Of The Provider | 405042759 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 273 |
| Number Of Services | 13300 |
| Number Of Medicare Beneficiaries | 7891 |
| Total Submitted Charge Amount | 1421451 |
| Total Medicare Allowed Amount | 430930.55 |
| Total Medicare Payment Amount | 324963.71 |
| Total Medicare Standardized Payment Amount | 347302.55 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
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| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 2239 |
| Number Of Beneficiaries Age 65 to 74 | 2572 |
| Number Of Beneficiaries Age 75 to 84 | 2028 |
| Number Of Beneficiaries Age Greater 84 | 1052 |
| Number Of Female Beneficiaries | 4526 |
| Number Of Male Beneficiaries | 3365 |
| Number Of Non Hispanic White Beneficiaries | 7399 |
| Number Of Black or African American Beneficiaries | 392 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 41 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 40 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4835 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 3056 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 39 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.807 |