| National Provider Identifier [NPI]: | 1457391005 |
| Last Name Of The Provider | HICKEY |
| First Name Of The Provider | GREGORY |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6681 RIDGE RD |
| Street Address 2 Of The Provider | SUITE 206 |
| City Of The Provider | PARMA |
| Zip Code Of The Provider | 441295713 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 53 |
| Number Of Services | 4641 |
| Number Of Medicare Beneficiaries | 1130 |
| Total Submitted Charge Amount | 907790 |
| Total Medicare Allowed Amount | 420477.64 |
| Total Medicare Payment Amount | 321845.84 |
| Total Medicare Standardized Payment Amount | 331872.42 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 80 |
| Number Of Medicare Beneficiaries With Drug Services | 63 |
| Total Drug Submitted ChargeAmount | 2390 |
| Total Drug Medicare AllowedAmount | 1018.66 |
| Total Drug Medicare PaymentAmount | 909.45 |
| Total Drug Medicare Standardized Payment Amount | 909.45 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 4561 |
| Number Of Medicare Beneficiaries With Medical Services | 1130 |
| Total Medical Submitted Charge Amount | 905400 |
| Total Medical Medicare Allowed Amount | 419458.98 |
| Total Medical Medicare Payment Amount | 320936.39 |
| Total Medical Medicare Standardized Payment Amount | 330962.97 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 119 |
| Number Of Beneficiaries Age 65 to 74 | 360 |
| Number Of Beneficiaries Age 75 to 84 | 382 |
| Number Of Beneficiaries Age Greater 84 | 269 |
| Number Of Female Beneficiaries | 598 |
| Number Of Male Beneficiaries | 532 |
| Number Of Non Hispanic White Beneficiaries | 1071 |
| Number Of Black or African American Beneficiaries | 24 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 923 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 207 |
| Percent Of With Atrial Fibrillation | 26 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 54 |
| Percent Of With Chronic Kidney Disease | 49 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 65 |
| Percent Of With Depression | 37 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 63 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.1817 |