| National Provider Identifier [NPI]: | 1669490413 |
| Last Name Of The Provider | HICKS |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | O |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 113 NATIONWIDE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | LYNCHBURG |
| Zip Code Of The Provider | 245024272 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 206 |
| Number Of Services | 25203 |
| Number Of Medicare Beneficiaries | 5613 |
| Total Submitted Charge Amount | 1169920.2 |
| Total Medicare Allowed Amount | 407239.92 |
| Total Medicare Payment Amount | 295758.29 |
| Total Medicare Standardized Payment Amount | 305664.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 16558 |
| Number Of Medicare Beneficiaries With Drug Services | 199 |
| Total Drug Submitted ChargeAmount | 10784.2 |
| Total Drug Medicare AllowedAmount | 4251.71 |
| Total Drug Medicare PaymentAmount | 3315.21 |
| Total Drug Medicare Standardized Payment Amount | 3315.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 203 |
| Number Of Medical Services | 8645 |
| Number Of Medicare Beneficiaries With Medical Services | 5613 |
| Total Medical Submitted Charge Amount | 1159136 |
| Total Medical Medicare Allowed Amount | 402988.21 |
| Total Medical Medicare Payment Amount | 292443.08 |
| Total Medical Medicare Standardized Payment Amount | 302349.24 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 1057 |
| Number Of Beneficiaries Age 65 to 74 | 1886 |
| Number Of Beneficiaries Age 75 to 84 | 1702 |
| Number Of Beneficiaries Age Greater 84 | 968 |
| Number Of Female Beneficiaries | 3301 |
| Number Of Male Beneficiaries | 2312 |
| Number Of Non Hispanic White Beneficiaries | 4381 |
| Number Of Black or African American Beneficiaries | 1152 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 46 |
| Number Of Beneficiaries With Medicare Only Entitlement | 4051 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1562 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.6322 |