| National Provider Identifier [NPI]: | 1639124803 |
| Last Name Of The Provider | KILCHESKI |
| First Name Of The Provider | THOMAS |
| 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 | 8881 FLETCHER PARKWAY #102 |
| Street Address 2 Of The Provider | |
| City Of The Provider | LA MESA |
| Zip Code Of The Provider | 91942 |
| 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 | 148 |
| Number Of Services | 4224 |
| Number Of Medicare Beneficiaries | 2596 |
| Total Submitted Charge Amount | 644443 |
| Total Medicare Allowed Amount | 187384.34 |
| Total Medicare Payment Amount | 151855.29 |
| Total Medicare Standardized Payment Amount | 146015.75 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 148 |
| Number Of Medical Services | 4224 |
| Number Of Medicare Beneficiaries With Medical Services | 2596 |
| Total Medical Submitted Charge Amount | 644443 |
| Total Medical Medicare Allowed Amount | 187384.34 |
| Total Medical Medicare Payment Amount | 151855.29 |
| Total Medical Medicare Standardized Payment Amount | 146015.75 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 509 |
| Number Of Beneficiaries Age 65 to 74 | 951 |
| Number Of Beneficiaries Age 75 to 84 | 696 |
| Number Of Beneficiaries Age Greater 84 | 440 |
| Number Of Female Beneficiaries | 1720 |
| Number Of Male Beneficiaries | 876 |
| Number Of Non Hispanic White Beneficiaries | 1916 |
| Number Of Black or African American Beneficiaries | 138 |
| Number Of AsianPacific Islander Beneficiaries | 126 |
| Number Of Hispanic Beneficiaries | 333 |
| Number Of American Indian Alaska Native Beneficiaries | 22 |
| Number Of Beneficiaries With Race Not Else where Classified | 61 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1469 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1127 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 23 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 15 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.9408 |