| National Provider Identifier [NPI]: | 1578675971 |
| Last Name Of The Provider | THEODORIS |
| First Name Of The Provider | ANTHONY |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 60 N COUNTRY RD |
| Street Address 2 Of The Provider | SUITE 203 |
| City Of The Provider | PORT JEFFERSON |
| Zip Code Of The Provider | 117772188 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 18734 |
| Number Of Medicare Beneficiaries | 892 |
| Total Submitted Charge Amount | 1305272.86 |
| Total Medicare Allowed Amount | 836296.93 |
| Total Medicare Payment Amount | 648050.94 |
| Total Medicare Standardized Payment Amount | 591518.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 14912 |
| Number Of Medicare Beneficiaries With Drug Services | 26 |
| Total Drug Submitted ChargeAmount | 745800 |
| Total Drug Medicare AllowedAmount | 400310.58 |
| Total Drug Medicare PaymentAmount | 313681.94 |
| Total Drug Medicare Standardized Payment Amount | 313681.94 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 3822 |
| Number Of Medicare Beneficiaries With Medical Services | 892 |
| Total Medical Submitted Charge Amount | 559472.86 |
| Total Medical Medicare Allowed Amount | 435986.35 |
| Total Medical Medicare Payment Amount | 334369 |
| Total Medical Medicare Standardized Payment Amount | 277836.22 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 135 |
| Number Of Beneficiaries Age 65 to 74 | 264 |
| Number Of Beneficiaries Age 75 to 84 | 291 |
| Number Of Beneficiaries Age Greater 84 | 202 |
| Number Of Female Beneficiaries | 535 |
| Number Of Male Beneficiaries | 357 |
| Number Of Non Hispanic White Beneficiaries | 820 |
| Number Of Black or African American Beneficiaries | 24 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 31 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 666 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 226 |
| Percent Of With Atrial Fibrillation | 30 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 25 |
| Percent Of With Cancer | 22 |
| Percent Of With Heart Failure | 48 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 59 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 66 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.2986 |