| National Provider Identifier [NPI]: | 1023210317 |
| Last Name Of The Provider | RODONAIA |
| First Name Of The Provider | GRIGORIY |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. PA |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2955 HARRISON ST |
| Street Address 2 Of The Provider | STE. 200 |
| City Of The Provider | BEAUMONT |
| Zip Code Of The Provider | 777021154 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 39 |
| Number Of Services | 1470 |
| Number Of Medicare Beneficiaries | 196 |
| Total Submitted Charge Amount | 110042.5 |
| Total Medicare Allowed Amount | 48415.55 |
| Total Medicare Payment Amount | 32096.01 |
| Total Medicare Standardized Payment Amount | 35229.15 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 690 |
| Number Of Medicare Beneficiaries With Drug Services | 75 |
| Total Drug Submitted ChargeAmount | 10512.5 |
| Total Drug Medicare AllowedAmount | 1054.97 |
| Total Drug Medicare PaymentAmount | 759.34 |
| Total Drug Medicare Standardized Payment Amount | 759.34 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 29 |
| Number Of Medical Services | 780 |
| Number Of Medicare Beneficiaries With Medical Services | 196 |
| Total Medical Submitted Charge Amount | 99530 |
| Total Medical Medicare Allowed Amount | 47360.58 |
| Total Medical Medicare Payment Amount | 31336.67 |
| Total Medical Medicare Standardized Payment Amount | 34469.81 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 44 |
| Number Of Beneficiaries Age 65 to 74 | 82 |
| Number Of Beneficiaries Age 75 to 84 | 50 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 106 |
| Number Of Male Beneficiaries | 90 |
| Number Of Non Hispanic White Beneficiaries | 175 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 165 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 31 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.2177 |