| National Provider Identifier [NPI]: | 1801004197 |
| Last Name Of The Provider | KICK |
| First Name Of The Provider | PHILLIP |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3640 MAIN ST |
| Street Address 2 Of The Provider | SUITE 103 |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 011071145 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 103 |
| Number Of Services | 4352 |
| Number Of Medicare Beneficiaries | 970 |
| Total Submitted Charge Amount | 1033190 |
| Total Medicare Allowed Amount | 374047.06 |
| Total Medicare Payment Amount | 275612.16 |
| Total Medicare Standardized Payment Amount | 271213.99 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 178 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 108448 |
| Total Drug Medicare AllowedAmount | 33421.6 |
| Total Drug Medicare PaymentAmount | 24390.07 |
| Total Drug Medicare Standardized Payment Amount | 24390.07 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 98 |
| Number Of Medical Services | 4174 |
| Number Of Medicare Beneficiaries With Medical Services | 970 |
| Total Medical Submitted Charge Amount | 924742 |
| Total Medical Medicare Allowed Amount | 340625.46 |
| Total Medical Medicare Payment Amount | 251222.09 |
| Total Medical Medicare Standardized Payment Amount | 246823.92 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 121 |
| Number Of Beneficiaries Age 65 to 74 | 371 |
| Number Of Beneficiaries Age 75 to 84 | 305 |
| Number Of Beneficiaries Age Greater 84 | 173 |
| Number Of Female Beneficiaries | 220 |
| Number Of Male Beneficiaries | 750 |
| Number Of Non Hispanic White Beneficiaries | 869 |
| Number Of Black or African American Beneficiaries | 29 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 49 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 772 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 198 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 25 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 3 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1976 |