| National Provider Identifier [NPI]: | 1508842659 |
| Last Name Of The Provider | GLICKSTEIN |
| First Name Of The Provider | MARC |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 85 SEYMOUR ST |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | HARTFORD |
| Zip Code Of The Provider | 061065501 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 164 |
| Number Of Services | 11547 |
| Number Of Medicare Beneficiaries | 2937 |
| Total Submitted Charge Amount | 942077 |
| Total Medicare Allowed Amount | 219918.55 |
| Total Medicare Payment Amount | 177641.54 |
| Total Medicare Standardized Payment Amount | 168373 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 7014 |
| Number Of Medicare Beneficiaries With Drug Services | 78 |
| Total Drug Submitted ChargeAmount | 21912 |
| Total Drug Medicare AllowedAmount | 1420.04 |
| Total Drug Medicare PaymentAmount | 1101.98 |
| Total Drug Medicare Standardized Payment Amount | 1101.98 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 161 |
| Number Of Medical Services | 4533 |
| Number Of Medicare Beneficiaries With Medical Services | 2936 |
| Total Medical Submitted Charge Amount | 920165 |
| Total Medical Medicare Allowed Amount | 218498.51 |
| Total Medical Medicare Payment Amount | 176539.56 |
| Total Medical Medicare Standardized Payment Amount | 167271.02 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 490 |
| Number Of Beneficiaries Age 65 to 74 | 1016 |
| Number Of Beneficiaries Age 75 to 84 | 856 |
| Number Of Beneficiaries Age Greater 84 | 575 |
| Number Of Female Beneficiaries | 1915 |
| Number Of Male Beneficiaries | 1022 |
| Number Of Non Hispanic White Beneficiaries | 2487 |
| Number Of Black or African American Beneficiaries | 170 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 209 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 44 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1986 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 951 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.6384 |