| National Provider Identifier [NPI]: | 1528030905 |
| Last Name Of The Provider | POULOS |
| First Name Of The Provider | EVANGELOS |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 16250 NW 59TH AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MIAMI LAKES |
| Zip Code Of The Provider | 330147542 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 14 |
| Number Of Services | 32275 |
| Number Of Medicare Beneficiaries | 10903 |
| Total Submitted Charge Amount | 5306602.45 |
| Total Medicare Allowed Amount | 1902093.97 |
| Total Medicare Payment Amount | 1455898.28 |
| Total Medicare Standardized Payment Amount | 987893.8 |
| 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 | 14 |
| Number Of Medical Services | 32275 |
| Number Of Medicare Beneficiaries With Medical Services | 10903 |
| Total Medical Submitted Charge Amount | 5306602.45 |
| Total Medical Medicare Allowed Amount | 1902093.97 |
| Total Medical Medicare Payment Amount | 1455898.28 |
| Total Medical Medicare Standardized Payment Amount | 987893.8 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 233 |
| Number Of Beneficiaries Age 65 to 74 | 4042 |
| Number Of Beneficiaries Age 75 to 84 | 4325 |
| Number Of Beneficiaries Age Greater 84 | 2303 |
| Number Of Female Beneficiaries | 5354 |
| Number Of Male Beneficiaries | 5549 |
| Number Of Non Hispanic White Beneficiaries | 10367 |
| Number Of Black or African American Beneficiaries | 56 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 326 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 122 |
| Number Of Beneficiaries With Medicare Only Entitlement | 10480 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 423 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1064 |