| National Provider Identifier [NPI]: | 1457315228 |
| Last Name Of The Provider | LEVI |
| First Name Of The Provider | ANGELIQUE |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2800 MAIN ST |
| Street Address 2 Of The Provider | ST. VINCENT'S MEDICAL CENTER, DEPT. OF PATHOLOGY |
| City Of The Provider | BRIDGEPORT |
| Zip Code Of The Provider | 066064201 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 23 |
| Number Of Services | 1001 |
| Number Of Medicare Beneficiaries | 425 |
| Total Submitted Charge Amount | 172544 |
| Total Medicare Allowed Amount | 36614.99 |
| Total Medicare Payment Amount | 28564.79 |
| Total Medicare Standardized Payment Amount | 23368.86 |
| 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 | 23 |
| Number Of Medical Services | 1001 |
| Number Of Medicare Beneficiaries With Medical Services | 425 |
| Total Medical Submitted Charge Amount | 172544 |
| Total Medical Medicare Allowed Amount | 36614.99 |
| Total Medical Medicare Payment Amount | 28564.79 |
| Total Medical Medicare Standardized Payment Amount | 23368.86 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 71 |
| Number Of Beneficiaries Age 65 to 74 | 166 |
| Number Of Beneficiaries Age 75 to 84 | 137 |
| Number Of Beneficiaries Age Greater 84 | 51 |
| Number Of Female Beneficiaries | 214 |
| Number Of Male Beneficiaries | 211 |
| Number Of Non Hispanic White Beneficiaries | 345 |
| Number Of Black or African American Beneficiaries | 34 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 32 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 305 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 120 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 25 |
| Percent Of With Heart Failure | 30 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.9211 |