| National Provider Identifier [NPI]: | 1194772590 |
| Last Name Of The Provider | GORENGAUT |
| First Name Of The Provider | VLADISLAV |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 701 N 1ST ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 627810001 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 189 |
| Number Of Services | 5594 |
| Number Of Medicare Beneficiaries | 3532 |
| Total Submitted Charge Amount | 961672 |
| Total Medicare Allowed Amount | 208265.31 |
| Total Medicare Payment Amount | 151763.14 |
| Total Medicare Standardized Payment Amount | 145698.03 |
| 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 | 189 |
| Number Of Medical Services | 5594 |
| Number Of Medicare Beneficiaries With Medical Services | 3532 |
| Total Medical Submitted Charge Amount | 961672 |
| Total Medical Medicare Allowed Amount | 208265.31 |
| Total Medical Medicare Payment Amount | 151763.14 |
| Total Medical Medicare Standardized Payment Amount | 145698.03 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 415 |
| Number Of Beneficiaries Age 65 to 74 | 1147 |
| Number Of Beneficiaries Age 75 to 84 | 1120 |
| Number Of Beneficiaries Age Greater 84 | 850 |
| Number Of Female Beneficiaries | 2135 |
| Number Of Male Beneficiaries | 1397 |
| Number Of Non Hispanic White Beneficiaries | 2989 |
| Number Of Black or African American Beneficiaries | 217 |
| Number Of AsianPacific Islander Beneficiaries | 89 |
| Number Of Hispanic Beneficiaries | 192 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 2830 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 702 |
| Percent Of With Atrial Fibrillation | 22 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 60 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 1.7819 |