| National Provider Identifier [NPI]: | 1386641454 |
| Last Name Of The Provider | KANISTROS |
| First Name Of The Provider | PETER |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4983 DELHI AVE |
| Street Address 2 Of The Provider | SUITE 6 |
| City Of The Provider | CINCINNATI |
| Zip Code Of The Provider | 452385380 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 169 |
| Number Of Services | 3602 |
| Number Of Medicare Beneficiaries | 2267 |
| Total Submitted Charge Amount | 352960 |
| Total Medicare Allowed Amount | 108850.9 |
| Total Medicare Payment Amount | 85444.77 |
| Total Medicare Standardized Payment Amount | 88270.63 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 169 |
| Number Of Medical Services | 3602 |
| Number Of Medicare Beneficiaries With Medical Services | 2267 |
| Total Medical Submitted Charge Amount | 352960 |
| Total Medical Medicare Allowed Amount | 108850.9 |
| Total Medical Medicare Payment Amount | 85444.77 |
| Total Medical Medicare Standardized Payment Amount | 88270.63 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 536 |
| Number Of Beneficiaries Age 65 to 74 | 689 |
| Number Of Beneficiaries Age 75 to 84 | 620 |
| Number Of Beneficiaries Age Greater 84 | 422 |
| Number Of Female Beneficiaries | 1472 |
| Number Of Male Beneficiaries | 795 |
| Number Of Non Hispanic White Beneficiaries | 1922 |
| Number Of Black or African American Beneficiaries | 300 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1614 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 653 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 1.6872 |