| National Provider Identifier [NPI]: | 1114159225 |
| Last Name Of The Provider | FORDOSKI |
| First Name Of The Provider | KRYSTAL |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | O.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 765 JOHNSONBURG RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAINT MARYS |
| Zip Code Of The Provider | 158573417 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Optometry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 2635 |
| Number Of Medicare Beneficiaries | 1010 |
| Total Submitted Charge Amount | 359655 |
| Total Medicare Allowed Amount | 231340.77 |
| Total Medicare Payment Amount | 154268.33 |
| Total Medicare Standardized Payment Amount | 163079.89 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 18 |
| Number Of Medical Services | 2635 |
| Number Of Medicare Beneficiaries With Medical Services | 1010 |
| Total Medical Submitted Charge Amount | 359655 |
| Total Medical Medicare Allowed Amount | 231340.77 |
| Total Medical Medicare Payment Amount | 154268.33 |
| Total Medical Medicare Standardized Payment Amount | 163079.89 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 363 |
| Number Of Beneficiaries Age 75 to 84 | 360 |
| Number Of Beneficiaries Age Greater 84 | 241 |
| Number Of Female Beneficiaries | 631 |
| Number Of Male Beneficiaries | 379 |
| Number Of Non Hispanic White Beneficiaries | 991 |
| Number Of Black or African American Beneficiaries | 0 |
| 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 | 908 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 102 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1436 |