| National Provider Identifier [NPI]: | 1689641136 |
| Last Name Of The Provider | KRACKOV |
| First Name Of The Provider | WARREN |
| 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 | 16400 NW 2ND AVENUE |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | MIAMI |
| Zip Code Of The Provider | 331696035 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 67019 |
| Number Of Medicare Beneficiaries | 633 |
| Total Submitted Charge Amount | 7613290 |
| Total Medicare Allowed Amount | 2481241.72 |
| Total Medicare Payment Amount | 1923052.7 |
| Total Medicare Standardized Payment Amount | 1958461.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 63180 |
| Number Of Medicare Beneficiaries With Drug Services | 526 |
| Total Drug Submitted ChargeAmount | 90506 |
| Total Drug Medicare AllowedAmount | 28969.3 |
| Total Drug Medicare PaymentAmount | 22711.27 |
| Total Drug Medicare Standardized Payment Amount | 22711.27 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 3839 |
| Number Of Medicare Beneficiaries With Medical Services | 633 |
| Total Medical Submitted Charge Amount | 7522784 |
| Total Medical Medicare Allowed Amount | 2452272.42 |
| Total Medical Medicare Payment Amount | 1900341.43 |
| Total Medical Medicare Standardized Payment Amount | 1935749.99 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 345 |
| Number Of Beneficiaries Age 65 to 74 | 152 |
| Number Of Beneficiaries Age 75 to 84 | 102 |
| Number Of Beneficiaries Age Greater 84 | 34 |
| Number Of Female Beneficiaries | 267 |
| Number Of Male Beneficiaries | 366 |
| Number Of Non Hispanic White Beneficiaries | 138 |
| Number Of Black or African American Beneficiaries | 265 |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| Number Of Hispanic Beneficiaries | 198 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 206 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 427 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 4 |
| Percent Of With Heart Failure | 62 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 72 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 71 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 30 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 8.3967 |