| National Provider Identifier [NPI]: | 1326004987 |
| Last Name Of The Provider | GROSSKREUTZ |
| First Name Of The Provider | SCOTT |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 82 PUUHONU PL |
| Street Address 2 Of The Provider | #102 |
| City Of The Provider | HILO |
| Zip Code Of The Provider | 96720 |
| State Code Of The Provider | HI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 157 |
| Number Of Services | 6135 |
| Number Of Medicare Beneficiaries | 1876 |
| Total Submitted Charge Amount | 1192748.96 |
| Total Medicare Allowed Amount | 267883.89 |
| Total Medicare Payment Amount | 212995.08 |
| Total Medicare Standardized Payment Amount | 193184.97 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 2716 |
| Number Of Medicare Beneficiaries With Drug Services | 60 |
| Total Drug Submitted ChargeAmount | 10488 |
| Total Drug Medicare AllowedAmount | 1206.68 |
| Total Drug Medicare PaymentAmount | 946 |
| Total Drug Medicare Standardized Payment Amount | 946 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 155 |
| Number Of Medical Services | 3419 |
| Number Of Medicare Beneficiaries With Medical Services | 1876 |
| Total Medical Submitted Charge Amount | 1182260.96 |
| Total Medical Medicare Allowed Amount | 266677.21 |
| Total Medical Medicare Payment Amount | 212049.08 |
| Total Medical Medicare Standardized Payment Amount | 192238.97 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 230 |
| Number Of Beneficiaries Age 65 to 74 | 847 |
| Number Of Beneficiaries Age 75 to 84 | 520 |
| Number Of Beneficiaries Age Greater 84 | 279 |
| Number Of Female Beneficiaries | 1293 |
| Number Of Male Beneficiaries | 583 |
| Number Of Non Hispanic White Beneficiaries | 652 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 875 |
| Number Of Hispanic Beneficiaries | 127 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 206 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1526 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 350 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.1724 |