| National Provider Identifier [NPI]: | 1275537979 |
| Last Name Of The Provider | KISH |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 12554 RIATA VISTA CIR |
| Street Address 2 Of The Provider | |
| City Of The Provider | AUSTIN |
| Zip Code Of The Provider | 787276431 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 246 |
| Number Of Services | 11860 |
| Number Of Medicare Beneficiaries | 2418 |
| Total Submitted Charge Amount | 906184.7 |
| Total Medicare Allowed Amount | 209738.06 |
| Total Medicare Payment Amount | 159551.85 |
| Total Medicare Standardized Payment Amount | 164382.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 7439 |
| Number Of Medicare Beneficiaries With Drug Services | 93 |
| Total Drug Submitted ChargeAmount | 6741.2 |
| Total Drug Medicare AllowedAmount | 1868.19 |
| Total Drug Medicare PaymentAmount | 1354.42 |
| Total Drug Medicare Standardized Payment Amount | 1354.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 241 |
| Number Of Medical Services | 4421 |
| Number Of Medicare Beneficiaries With Medical Services | 2418 |
| Total Medical Submitted Charge Amount | 899443.5 |
| Total Medical Medicare Allowed Amount | 207869.87 |
| Total Medical Medicare Payment Amount | 158197.43 |
| Total Medical Medicare Standardized Payment Amount | 163028.39 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 404 |
| Number Of Beneficiaries Age 65 to 74 | 927 |
| Number Of Beneficiaries Age 75 to 84 | 710 |
| Number Of Beneficiaries Age Greater 84 | 377 |
| Number Of Female Beneficiaries | 1357 |
| Number Of Male Beneficiaries | 1061 |
| Number Of Non Hispanic White Beneficiaries | 1739 |
| Number Of Black or African American Beneficiaries | 199 |
| Number Of AsianPacific Islander Beneficiaries | 32 |
| Number Of Hispanic Beneficiaries | 423 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1787 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 631 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 35 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.009 |