| National Provider Identifier [NPI]: | 1013179829 |
| Last Name Of The Provider | GUSSICK |
| First Name Of The Provider | SEAN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1701 N SENATE BLVD |
| Street Address 2 Of The Provider | RADIOLOGY DEPT |
| City Of The Provider | INDIANAPOLIS |
| Zip Code Of The Provider | 462021239 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 96 |
| Number Of Services | 5155 |
| Number Of Medicare Beneficiaries | 3303 |
| Total Submitted Charge Amount | 352616 |
| Total Medicare Allowed Amount | 118892.19 |
| Total Medicare Payment Amount | 87496.22 |
| Total Medicare Standardized Payment Amount | 91997.76 |
| 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 | 96 |
| Number Of Medical Services | 5155 |
| Number Of Medicare Beneficiaries With Medical Services | 3303 |
| Total Medical Submitted Charge Amount | 352616 |
| Total Medical Medicare Allowed Amount | 118892.19 |
| Total Medical Medicare Payment Amount | 87496.22 |
| Total Medical Medicare Standardized Payment Amount | 91997.76 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 1088 |
| Number Of Beneficiaries Age 65 to 74 | 980 |
| Number Of Beneficiaries Age 75 to 84 | 768 |
| Number Of Beneficiaries Age Greater 84 | 467 |
| Number Of Female Beneficiaries | 1820 |
| Number Of Male Beneficiaries | 1483 |
| Number Of Non Hispanic White Beneficiaries | 2719 |
| Number Of Black or African American Beneficiaries | 510 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 30 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 32 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1878 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1425 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 40 |
| Percent Of With Depression | 47 |
| Percent Of With Diabetes | 46 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 13 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.2957 |