| National Provider Identifier [NPI]: | 1619969078 |
| Last Name Of The Provider | LICCINI |
| First Name Of The Provider | RAYMOND |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 12645 NEW BRITTANY BLVD |
| Street Address 2 Of The Provider | BLDG 15 |
| City Of The Provider | FORT MYERS |
| Zip Code Of The Provider | 339073631 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 76 |
| Number Of Services | 7517 |
| Number Of Medicare Beneficiaries | 1735 |
| Total Submitted Charge Amount | 1315316 |
| Total Medicare Allowed Amount | 638814.22 |
| Total Medicare Payment Amount | 481831.91 |
| Total Medicare Standardized Payment Amount | 458918.02 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 358 |
| Number Of Medicare Beneficiaries With Drug Services | 80 |
| Total Drug Submitted ChargeAmount | 5177 |
| Total Drug Medicare AllowedAmount | 1579.57 |
| Total Drug Medicare PaymentAmount | 1182.66 |
| Total Drug Medicare Standardized Payment Amount | 1182.66 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 71 |
| Number Of Medical Services | 7159 |
| Number Of Medicare Beneficiaries With Medical Services | 1735 |
| Total Medical Submitted Charge Amount | 1310139 |
| Total Medical Medicare Allowed Amount | 637234.65 |
| Total Medical Medicare Payment Amount | 480649.25 |
| Total Medical Medicare Standardized Payment Amount | 457735.36 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 140 |
| Number Of Beneficiaries Age 65 to 74 | 636 |
| Number Of Beneficiaries Age 75 to 84 | 638 |
| Number Of Beneficiaries Age Greater 84 | 321 |
| Number Of Female Beneficiaries | 722 |
| Number Of Male Beneficiaries | 1013 |
| Number Of Non Hispanic White Beneficiaries | 1575 |
| Number Of Black or African American Beneficiaries | 57 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 67 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1577 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 158 |
| Percent Of With Atrial Fibrillation | 30 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 23 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.8769 |