| National Provider Identifier [NPI]: | 1770566382 |
| Last Name Of The Provider | THEODORAN |
| First Name Of The Provider | CHRIS |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2106 HARRISBURG PIKE |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | LANCASTER |
| Zip Code Of The Provider | 176012644 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 98 |
| Number Of Services | 6299 |
| Number Of Medicare Beneficiaries | 947 |
| Total Submitted Charge Amount | 721809.6 |
| Total Medicare Allowed Amount | 266257.44 |
| Total Medicare Payment Amount | 195030.14 |
| Total Medicare Standardized Payment Amount | 201313.37 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 2466 |
| Number Of Medicare Beneficiaries With Drug Services | 40 |
| Total Drug Submitted ChargeAmount | 111931.6 |
| Total Drug Medicare AllowedAmount | 44368.24 |
| Total Drug Medicare PaymentAmount | 33645.29 |
| Total Drug Medicare Standardized Payment Amount | 33645.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 91 |
| Number Of Medical Services | 3833 |
| Number Of Medicare Beneficiaries With Medical Services | 947 |
| Total Medical Submitted Charge Amount | 609878 |
| Total Medical Medicare Allowed Amount | 221889.2 |
| Total Medical Medicare Payment Amount | 161384.85 |
| Total Medical Medicare Standardized Payment Amount | 167668.08 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 55 |
| Number Of Beneficiaries Age 65 to 74 | 300 |
| Number Of Beneficiaries Age 75 to 84 | 376 |
| Number Of Beneficiaries Age Greater 84 | 216 |
| Number Of Female Beneficiaries | 187 |
| Number Of Male Beneficiaries | 760 |
| Number Of Non Hispanic White Beneficiaries | 918 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 862 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 85 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 26 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.4423 |