| National Provider Identifier [NPI]: | 1184664930 |
| Last Name Of The Provider | KIZEWIC |
| First Name Of The Provider | CRAIG |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 501 6TH AVE S |
| Street Address 2 Of The Provider | DPT 70-6590 |
| City Of The Provider | ST PETERSBURG |
| Zip Code Of The Provider | 337014634 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 682 |
| Number Of Medicare Beneficiaries | 611 |
| Total Submitted Charge Amount | 949773 |
| Total Medicare Allowed Amount | 113091.73 |
| Total Medicare Payment Amount | 86710.66 |
| Total Medicare Standardized Payment Amount | 85122.97 |
| 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 | 21 |
| Number Of Medical Services | 682 |
| Number Of Medicare Beneficiaries With Medical Services | 611 |
| Total Medical Submitted Charge Amount | 949773 |
| Total Medical Medicare Allowed Amount | 113091.73 |
| Total Medical Medicare Payment Amount | 86710.66 |
| Total Medical Medicare Standardized Payment Amount | 85122.97 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 92 |
| Number Of Beneficiaries Age 65 to 74 | 157 |
| Number Of Beneficiaries Age 75 to 84 | 158 |
| Number Of Beneficiaries Age Greater 84 | 204 |
| Number Of Female Beneficiaries | 353 |
| Number Of Male Beneficiaries | 258 |
| Number Of Non Hispanic White Beneficiaries | 557 |
| Number Of Black or African American Beneficiaries | 15 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 481 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 130 |
| Percent Of With Atrial Fibrillation | 26 |
| Percent Of With Alzheimers Disease or Dementia | 31 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 46 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 68 |
| Percent Of With Osteoporosis | 21 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 58 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.0714 |