| National Provider Identifier [NPI]: | 1417121120 |
| Last Name Of The Provider | GRONKIEWICZ |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 200 HAWKINS DR |
| Street Address 2 Of The Provider | DEPT OF RADIOLOGY |
| City Of The Provider | IOWA CITY |
| Zip Code Of The Provider | 522421009 |
| State Code Of The Provider | IA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 173 |
| Number Of Services | 4791 |
| Number Of Medicare Beneficiaries | 2260 |
| Total Submitted Charge Amount | 510685.8 |
| Total Medicare Allowed Amount | 130700 |
| Total Medicare Payment Amount | 101479.88 |
| Total Medicare Standardized Payment Amount | 105376.07 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 1290 |
| Number Of Medicare Beneficiaries With Drug Services | 16 |
| Total Drug Submitted ChargeAmount | 2895 |
| Total Drug Medicare AllowedAmount | 359.36 |
| Total Drug Medicare PaymentAmount | 281.75 |
| Total Drug Medicare Standardized Payment Amount | 281.75 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 170 |
| Number Of Medical Services | 3501 |
| Number Of Medicare Beneficiaries With Medical Services | 2259 |
| Total Medical Submitted Charge Amount | 507790.8 |
| Total Medical Medicare Allowed Amount | 130340.64 |
| Total Medical Medicare Payment Amount | 101198.13 |
| Total Medical Medicare Standardized Payment Amount | 105094.32 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 496 |
| Number Of Beneficiaries Age 65 to 74 | 790 |
| Number Of Beneficiaries Age 75 to 84 | 634 |
| Number Of Beneficiaries Age Greater 84 | 340 |
| Number Of Female Beneficiaries | 1369 |
| Number Of Male Beneficiaries | 891 |
| Number Of Non Hispanic White Beneficiaries | 1939 |
| Number Of Black or African American Beneficiaries | 190 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 96 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 20 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1563 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 697 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.8337 |