| National Provider Identifier [NPI]: | 1578680724 |
| Last Name Of The Provider | COSTOUROS |
| First Name Of The Provider | NICK |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 795 EL CAMINO REAL |
| Street Address 2 Of The Provider | |
| City Of The Provider | PALO ALTO |
| Zip Code Of The Provider | 943012302 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 177 |
| Number Of Services | 12258 |
| Number Of Medicare Beneficiaries | 1953 |
| Total Submitted Charge Amount | 1870421.5 |
| Total Medicare Allowed Amount | 546443.27 |
| Total Medicare Payment Amount | 428586.57 |
| Total Medicare Standardized Payment Amount | 375751.49 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 9435 |
| Number Of Medicare Beneficiaries With Drug Services | 152 |
| Total Drug Submitted ChargeAmount | 40822 |
| Total Drug Medicare AllowedAmount | 12957.51 |
| Total Drug Medicare PaymentAmount | 10155.61 |
| Total Drug Medicare Standardized Payment Amount | 10155.61 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 167 |
| Number Of Medical Services | 2823 |
| Number Of Medicare Beneficiaries With Medical Services | 1953 |
| Total Medical Submitted Charge Amount | 1829599.5 |
| Total Medical Medicare Allowed Amount | 533485.76 |
| Total Medical Medicare Payment Amount | 418430.96 |
| Total Medical Medicare Standardized Payment Amount | 365595.88 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 99 |
| Number Of Beneficiaries Age 65 to 74 | 985 |
| Number Of Beneficiaries Age 75 to 84 | 631 |
| Number Of Beneficiaries Age Greater 84 | 238 |
| Number Of Female Beneficiaries | 1333 |
| Number Of Male Beneficiaries | 620 |
| Number Of Non Hispanic White Beneficiaries | 1360 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 338 |
| Number Of Hispanic Beneficiaries | 110 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 77 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1667 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 286 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9885 |