| National Provider Identifier [NPI]: | 1992984512 |
| Last Name Of The Provider | KUSHEN |
| First Name Of The Provider | MEDINA |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3680 BROADWAY |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT MYERS |
| Zip Code Of The Provider | 339018005 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 80 |
| Number Of Services | 8867 |
| Number Of Medicare Beneficiaries | 3016 |
| Total Submitted Charge Amount | 2617689.79 |
| Total Medicare Allowed Amount | 1030315.9 |
| Total Medicare Payment Amount | 802463.63 |
| Total Medicare Standardized Payment Amount | 783370.49 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 3513 |
| Number Of Medicare Beneficiaries With Drug Services | 148 |
| Total Drug Submitted ChargeAmount | 14193.8 |
| Total Drug Medicare AllowedAmount | 9086.39 |
| Total Drug Medicare PaymentAmount | 7123.52 |
| Total Drug Medicare Standardized Payment Amount | 7123.52 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 74 |
| Number Of Medical Services | 5354 |
| Number Of Medicare Beneficiaries With Medical Services | 3016 |
| Total Medical Submitted Charge Amount | 2603495.99 |
| Total Medical Medicare Allowed Amount | 1021229.51 |
| Total Medical Medicare Payment Amount | 795340.11 |
| Total Medical Medicare Standardized Payment Amount | 776246.97 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 213 |
| Number Of Beneficiaries Age 65 to 74 | 1339 |
| Number Of Beneficiaries Age 75 to 84 | 1097 |
| Number Of Beneficiaries Age Greater 84 | 367 |
| Number Of Female Beneficiaries | 1530 |
| Number Of Male Beneficiaries | 1486 |
| Number Of Non Hispanic White Beneficiaries | 2660 |
| Number Of Black or African American Beneficiaries | 108 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 180 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 45 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2649 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 367 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 55 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 2.0365 |