| National Provider Identifier [NPI]: | 1831278027 |
| Last Name Of The Provider | BOLDUAN |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1615 WINSTED DR STE 4 |
| Street Address 2 Of The Provider | |
| City Of The Provider | GOSHEN |
| Zip Code Of The Provider | 465264673 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 74 |
| Number Of Services | 5507 |
| Number Of Medicare Beneficiaries | 431 |
| Total Submitted Charge Amount | 1385022.79 |
| Total Medicare Allowed Amount | 399923.17 |
| Total Medicare Payment Amount | 302428.04 |
| Total Medicare Standardized Payment Amount | 315109.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 2619 |
| Number Of Medicare Beneficiaries With Drug Services | 53 |
| Total Drug Submitted ChargeAmount | 379179.79 |
| Total Drug Medicare AllowedAmount | 124913.84 |
| Total Drug Medicare PaymentAmount | 97628.64 |
| Total Drug Medicare Standardized Payment Amount | 97628.64 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 68 |
| Number Of Medical Services | 2888 |
| Number Of Medicare Beneficiaries With Medical Services | 431 |
| Total Medical Submitted Charge Amount | 1005843 |
| Total Medical Medicare Allowed Amount | 275009.33 |
| Total Medical Medicare Payment Amount | 204799.4 |
| Total Medical Medicare Standardized Payment Amount | 217480.58 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 27 |
| Number Of Beneficiaries Age 65 to 74 | 161 |
| Number Of Beneficiaries Age 75 to 84 | 159 |
| Number Of Beneficiaries Age Greater 84 | 84 |
| Number Of Female Beneficiaries | 104 |
| Number Of Male Beneficiaries | 327 |
| Number Of Non Hispanic White Beneficiaries | 407 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 369 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 62 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 24 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3329 |