| National Provider Identifier [NPI]: | 1477743383 |
| Last Name Of The Provider | GOSTENIK |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 580 W COLLEGE AVE |
| Street Address 2 Of The Provider | MARQUETTE GENERAL HOSPITAL |
| City Of The Provider | MARQUETTE |
| Zip Code Of The Provider | 498552705 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 164 |
| Number Of Services | 4495 |
| Number Of Medicare Beneficiaries | 2605 |
| Total Submitted Charge Amount | 570252 |
| Total Medicare Allowed Amount | 157325.52 |
| Total Medicare Payment Amount | 118219.3 |
| Total Medicare Standardized Payment Amount | 122505.35 |
| 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 | 164 |
| Number Of Medical Services | 4495 |
| Number Of Medicare Beneficiaries With Medical Services | 2605 |
| Total Medical Submitted Charge Amount | 570252 |
| Total Medical Medicare Allowed Amount | 157325.52 |
| Total Medical Medicare Payment Amount | 118219.3 |
| Total Medical Medicare Standardized Payment Amount | 122505.35 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 534 |
| Number Of Beneficiaries Age 65 to 74 | 984 |
| Number Of Beneficiaries Age 75 to 84 | 734 |
| Number Of Beneficiaries Age Greater 84 | 353 |
| Number Of Female Beneficiaries | 1411 |
| Number Of Male Beneficiaries | 1194 |
| Number Of Non Hispanic White Beneficiaries | 2484 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | 73 |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1969 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 636 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.5026 |