| National Provider Identifier [NPI]: | 1689676777 |
| Last Name Of The Provider | ANTALIS |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1502 DEERPATH DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | CAMBRIDGE |
| Zip Code Of The Provider | 437259240 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 51 |
| Number Of Services | 3726.5 |
| Number Of Medicare Beneficiaries | 999 |
| Total Submitted Charge Amount | 821650 |
| Total Medicare Allowed Amount | 453387.56 |
| Total Medicare Payment Amount | 328091.85 |
| Total Medicare Standardized Payment Amount | 344762.78 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
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| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 95 |
| Number Of Beneficiaries Age 65 to 74 | 391 |
| Number Of Beneficiaries Age 75 to 84 | 374 |
| Number Of Beneficiaries Age Greater 84 | 139 |
| Number Of Female Beneficiaries | 593 |
| Number Of Male Beneficiaries | 406 |
| Number Of Non Hispanic White Beneficiaries | 967 |
| Number Of Black or African American Beneficiaries | 16 |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 777 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 222 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 40 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.1927 |