| National Provider Identifier [NPI]: | 1447461264 |
| Last Name Of The Provider | STATKUS |
| First Name Of The Provider | NICHOLAS |
| 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 | 1024 S LEMAY AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT COLLINS |
| Zip Code Of The Provider | 805243929 |
| State Code Of The Provider | CO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 207 |
| Number Of Services | 16130 |
| Number Of Medicare Beneficiaries | 4741 |
| Total Submitted Charge Amount | 1265410.6 |
| Total Medicare Allowed Amount | 424671.8 |
| Total Medicare Payment Amount | 331643.74 |
| Total Medicare Standardized Payment Amount | 320591.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 8910 |
| Number Of Medicare Beneficiaries With Drug Services | 113 |
| Total Drug Submitted ChargeAmount | 10774 |
| Total Drug Medicare AllowedAmount | 2906.67 |
| Total Drug Medicare PaymentAmount | 2264.31 |
| Total Drug Medicare Standardized Payment Amount | 2264.31 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 202 |
| Number Of Medical Services | 7220 |
| Number Of Medicare Beneficiaries With Medical Services | 4741 |
| Total Medical Submitted Charge Amount | 1254636.6 |
| Total Medical Medicare Allowed Amount | 421765.13 |
| Total Medical Medicare Payment Amount | 329379.43 |
| Total Medical Medicare Standardized Payment Amount | 318327.3 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 937 |
| Number Of Beneficiaries Age 65 to 74 | 1816 |
| Number Of Beneficiaries Age 75 to 84 | 1322 |
| Number Of Beneficiaries Age Greater 84 | 666 |
| Number Of Female Beneficiaries | 2943 |
| Number Of Male Beneficiaries | 1798 |
| Number Of Non Hispanic White Beneficiaries | 4248 |
| Number Of Black or African American Beneficiaries | 38 |
| Number Of AsianPacific Islander Beneficiaries | 45 |
| Number Of Hispanic Beneficiaries | 274 |
| Number Of American Indian Alaska Native Beneficiaries | 88 |
| Number Of Beneficiaries With Race Not Else where Classified | 48 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3343 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1398 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.4375 |