| National Provider Identifier [NPI]: | 1528087913 |
| Last Name Of The Provider | KOZLOV |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | B |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6447 LOCKWOOD LN |
| Street Address 2 Of The Provider | |
| City Of The Provider | GURNEE |
| Zip Code Of The Provider | 600315699 |
| 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 | 321 |
| Number Of Services | 9881 |
| Number Of Medicare Beneficiaries | 4856 |
| Total Submitted Charge Amount | 2228569 |
| Total Medicare Allowed Amount | 371504.64 |
| Total Medicare Payment Amount | 278470.94 |
| Total Medicare Standardized Payment Amount | 266104.13 |
| 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 | 321 |
| Number Of Medical Services | 9881 |
| Number Of Medicare Beneficiaries With Medical Services | 4856 |
| Total Medical Submitted Charge Amount | 2228569 |
| Total Medical Medicare Allowed Amount | 371504.64 |
| Total Medical Medicare Payment Amount | 278470.94 |
| Total Medical Medicare Standardized Payment Amount | 266104.13 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 855 |
| Number Of Beneficiaries Age 65 to 74 | 1549 |
| Number Of Beneficiaries Age 75 to 84 | 1428 |
| Number Of Beneficiaries Age Greater 84 | 1024 |
| Number Of Female Beneficiaries | 2718 |
| Number Of Male Beneficiaries | 2138 |
| Number Of Non Hispanic White Beneficiaries | 4003 |
| Number Of Black or African American Beneficiaries | 501 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 256 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 54 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3476 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1380 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 25 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 37 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 66 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 59 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.062 |