| National Provider Identifier [NPI]: | 1902070519 |
| Last Name Of The Provider | SHKUROVICH |
| First Name Of The Provider | SERGEY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 239 GREENE ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MILL VALLEY |
| Zip Code Of The Provider | 949413516 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 185 |
| Number Of Services | 16580 |
| Number Of Medicare Beneficiaries | 2650 |
| Total Submitted Charge Amount | 1360684.94 |
| Total Medicare Allowed Amount | 460146.45 |
| Total Medicare Payment Amount | 360904.96 |
| Total Medicare Standardized Payment Amount | 309481.6 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 10906 |
| Number Of Medicare Beneficiaries With Drug Services | 168 |
| Total Drug Submitted ChargeAmount | 41563.23 |
| Total Drug Medicare AllowedAmount | 3275.92 |
| Total Drug Medicare PaymentAmount | 2460.39 |
| Total Drug Medicare Standardized Payment Amount | 2460.39 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 182 |
| Number Of Medical Services | 5674 |
| Number Of Medicare Beneficiaries With Medical Services | 2649 |
| Total Medical Submitted Charge Amount | 1319121.71 |
| Total Medical Medicare Allowed Amount | 456870.53 |
| Total Medical Medicare Payment Amount | 358444.57 |
| Total Medical Medicare Standardized Payment Amount | 307021.21 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 456 |
| Number Of Beneficiaries Age 65 to 74 | 943 |
| Number Of Beneficiaries Age 75 to 84 | 757 |
| Number Of Beneficiaries Age Greater 84 | 494 |
| Number Of Female Beneficiaries | 1728 |
| Number Of Male Beneficiaries | 922 |
| Number Of Non Hispanic White Beneficiaries | 1643 |
| Number Of Black or African American Beneficiaries | 362 |
| Number Of AsianPacific Islander Beneficiaries | 267 |
| Number Of Hispanic Beneficiaries | 303 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1883 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 767 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5551 |