| National Provider Identifier [NPI]: | 1336149053 |
| Last Name Of The Provider | CIVANTOS |
| First Name Of The Provider | JOSEPH |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 71 W 156TH ST |
| Street Address 2 Of The Provider | SUITE 400 |
| City Of The Provider | HARVEY |
| Zip Code Of The Provider | 604264265 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 50 |
| Number Of Services | 13037 |
| Number Of Medicare Beneficiaries | 1558 |
| Total Submitted Charge Amount | 4095974.37 |
| Total Medicare Allowed Amount | 3164622.64 |
| Total Medicare Payment Amount | 2412727.43 |
| Total Medicare Standardized Payment Amount | 2374717.74 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 4488 |
| Number Of Medicare Beneficiaries With Drug Services | 349 |
| Total Drug Submitted ChargeAmount | 2381570.05 |
| Total Drug Medicare AllowedAmount | 2261456.89 |
| Total Drug Medicare PaymentAmount | 1755571.67 |
| Total Drug Medicare Standardized Payment Amount | 1755571.67 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 8549 |
| Number Of Medicare Beneficiaries With Medical Services | 1558 |
| Total Medical Submitted Charge Amount | 1714404.32 |
| Total Medical Medicare Allowed Amount | 903165.75 |
| Total Medical Medicare Payment Amount | 657155.76 |
| Total Medical Medicare Standardized Payment Amount | 619146.07 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 135 |
| Number Of Beneficiaries Age 65 to 74 | 545 |
| Number Of Beneficiaries Age 75 to 84 | 500 |
| Number Of Beneficiaries Age Greater 84 | 378 |
| Number Of Female Beneficiaries | 919 |
| Number Of Male Beneficiaries | 639 |
| Number Of Non Hispanic White Beneficiaries | 1277 |
| Number Of Black or African American Beneficiaries | 115 |
| Number Of AsianPacific Islander Beneficiaries | 18 |
| Number Of Hispanic Beneficiaries | 135 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1355 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 203 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 21 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.4816 |