| National Provider Identifier [NPI]: | 1508876871 |
| Last Name Of The Provider | KOELLIKER |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2014 WASHINGTON ST |
| Street Address 2 Of The Provider | PATHOLOGY DEPARTMENT, NEWTON-WELLESLEY HOSPITAL |
| City Of The Provider | NEWTON |
| Zip Code Of The Provider | 024621607 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 28 |
| Number Of Services | 2031 |
| Number Of Medicare Beneficiaries | 635 |
| Total Submitted Charge Amount | 253988 |
| Total Medicare Allowed Amount | 64416.68 |
| Total Medicare Payment Amount | 50093.8 |
| Total Medicare Standardized Payment Amount | 40021.38 |
| 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 | 28 |
| Number Of Medical Services | 2031 |
| Number Of Medicare Beneficiaries With Medical Services | 635 |
| Total Medical Submitted Charge Amount | 253988 |
| Total Medical Medicare Allowed Amount | 64416.68 |
| Total Medical Medicare Payment Amount | 50093.8 |
| Total Medical Medicare Standardized Payment Amount | 40021.38 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 45 |
| Number Of Beneficiaries Age 65 to 74 | 298 |
| Number Of Beneficiaries Age 75 to 84 | 204 |
| Number Of Beneficiaries Age Greater 84 | 88 |
| Number Of Female Beneficiaries | 360 |
| Number Of Male Beneficiaries | 275 |
| Number Of Non Hispanic White Beneficiaries | 592 |
| 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 | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 560 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 75 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 25 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 29 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2432 |