| National Provider Identifier [NPI]: | 1114911369 |
| Last Name Of The Provider | MATWIJIW |
| First Name Of The Provider | IGOR |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2604 ST MICHAEL DR |
| Street Address 2 Of The Provider | STE 310 |
| City Of The Provider | TEXARKANA |
| Zip Code Of The Provider | 755032373 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Endocrinology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 4560 |
| Number Of Medicare Beneficiaries | 787 |
| Total Submitted Charge Amount | 360018 |
| Total Medicare Allowed Amount | 160382.63 |
| Total Medicare Payment Amount | 108456.51 |
| Total Medicare Standardized Payment Amount | 119234.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 54 |
| Number Of Medicare Beneficiaries With Drug Services | 54 |
| Total Drug Submitted ChargeAmount | 1080 |
| Total Drug Medicare AllowedAmount | 830.3 |
| Total Drug Medicare PaymentAmount | 813.59 |
| Total Drug Medicare Standardized Payment Amount | 813.59 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 13 |
| Number Of Medical Services | 4506 |
| Number Of Medicare Beneficiaries With Medical Services | 787 |
| Total Medical Submitted Charge Amount | 358938 |
| Total Medical Medicare Allowed Amount | 159552.33 |
| Total Medical Medicare Payment Amount | 107642.92 |
| Total Medical Medicare Standardized Payment Amount | 118421.22 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 213 |
| Number Of Beneficiaries Age 65 to 74 | 370 |
| Number Of Beneficiaries Age 75 to 84 | 185 |
| Number Of Beneficiaries Age Greater 84 | 19 |
| Number Of Female Beneficiaries | 524 |
| Number Of Male Beneficiaries | 263 |
| Number Of Non Hispanic White Beneficiaries | 614 |
| Number Of Black or African American Beneficiaries | 153 |
| 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 | 615 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 172 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 22 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 69 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.296 |