| National Provider Identifier [NPI]: | 1821049198 |
| Last Name Of The Provider | KANUCKEL |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | PAC |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3000 MACK RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | FAIRFIELD |
| Zip Code Of The Provider | 450145335 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 381 |
| Number Of Medicare Beneficiaries | 183 |
| Total Submitted Charge Amount | 48540 |
| Total Medicare Allowed Amount | 22297.05 |
| Total Medicare Payment Amount | 14094.71 |
| Total Medicare Standardized Payment Amount | 18006.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 73 |
| Number Of Medicare Beneficiaries With Drug Services | 28 |
| Total Drug Submitted ChargeAmount | 1727 |
| Total Drug Medicare AllowedAmount | 215.05 |
| Total Drug Medicare PaymentAmount | 126.43 |
| Total Drug Medicare Standardized Payment Amount | 126.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 308 |
| Number Of Medicare Beneficiaries With Medical Services | 183 |
| Total Medical Submitted Charge Amount | 46813 |
| Total Medical Medicare Allowed Amount | 22082 |
| Total Medical Medicare Payment Amount | 13968.28 |
| Total Medical Medicare Standardized Payment Amount | 17880.41 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 68 |
| Number Of Beneficiaries Age 65 to 74 | 60 |
| Number Of Beneficiaries Age 75 to 84 | 35 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 106 |
| Number Of Male Beneficiaries | 77 |
| Number Of Non Hispanic White Beneficiaries | 168 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 117 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 66 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 58 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.022 |