| National Provider Identifier [NPI]: | 1407837651 |
| Last Name Of The Provider | KORNACK |
| First Name Of The Provider | FULTON |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1153 CENTRE ST |
| Street Address 2 Of The Provider | SUITE 54 |
| City Of The Provider | JAMAICA PLAIN |
| Zip Code Of The Provider | 021303446 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 72 |
| Number Of Services | 3757 |
| Number Of Medicare Beneficiaries | 444 |
| Total Submitted Charge Amount | 527438.92 |
| Total Medicare Allowed Amount | 169583.94 |
| Total Medicare Payment Amount | 126160.88 |
| Total Medicare Standardized Payment Amount | 118226.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 2370 |
| Number Of Medicare Beneficiaries With Drug Services | 226 |
| Total Drug Submitted ChargeAmount | 62251.92 |
| Total Drug Medicare AllowedAmount | 16519.46 |
| Total Drug Medicare PaymentAmount | 12695.29 |
| Total Drug Medicare Standardized Payment Amount | 12695.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 67 |
| Number Of Medical Services | 1387 |
| Number Of Medicare Beneficiaries With Medical Services | 444 |
| Total Medical Submitted Charge Amount | 465187 |
| Total Medical Medicare Allowed Amount | 153064.48 |
| Total Medical Medicare Payment Amount | 113465.59 |
| Total Medical Medicare Standardized Payment Amount | 105531.53 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 52 |
| Number Of Beneficiaries Age 65 to 74 | 196 |
| Number Of Beneficiaries Age 75 to 84 | 135 |
| Number Of Beneficiaries Age Greater 84 | 61 |
| Number Of Female Beneficiaries | 270 |
| Number Of Male Beneficiaries | 174 |
| Number Of Non Hispanic White Beneficiaries | 413 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 368 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 76 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 71 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9976 |