| National Provider Identifier [NPI]: | 1255348785 |
| Last Name Of The Provider | HACKSHAW |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 480 MEDICAL CENTER DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | COLUMBUS |
| Zip Code Of The Provider | 432101229 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Rheumatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 23843 |
| Number Of Medicare Beneficiaries | 622 |
| Total Submitted Charge Amount | 2860264.5 |
| Total Medicare Allowed Amount | 1011404.46 |
| Total Medicare Payment Amount | 758579.92 |
| Total Medicare Standardized Payment Amount | 764260.56 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 27 |
| Number Of Drug Services | 22440 |
| Number Of Medicare Beneficiaries With Drug Services | 148 |
| Total Drug Submitted ChargeAmount | 2341865.5 |
| Total Drug Medicare AllowedAmount | 817263.83 |
| Total Drug Medicare PaymentAmount | 616494.99 |
| Total Drug Medicare Standardized Payment Amount | 616494.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 1403 |
| Number Of Medicare Beneficiaries With Medical Services | 621 |
| Total Medical Submitted Charge Amount | 518399 |
| Total Medical Medicare Allowed Amount | 194140.63 |
| Total Medical Medicare Payment Amount | 142084.93 |
| Total Medical Medicare Standardized Payment Amount | 147765.57 |
| Average Age Of Beneficiaries | 60 |
| Number Of Beneficiaries Age Less65 | 359 |
| Number Of Beneficiaries Age 65 to 74 | 187 |
| Number Of Beneficiaries Age 75 to 84 | 62 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 485 |
| Number Of Male Beneficiaries | 137 |
| Number Of Non Hispanic White Beneficiaries | 423 |
| Number Of Black or African American Beneficiaries | 174 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 368 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 254 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 24 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 69 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.3994 |