| National Provider Identifier [NPI]: | 1396047924 |
| Last Name Of The Provider | SANTOS |
| First Name Of The Provider | LYDIA |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | CRNA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 GUSTAVE L LEVY PL |
| Street Address 2 Of The Provider | ANESTHESIOLOGY - BOX 1010 |
| City Of The Provider | NEW YORK |
| Zip Code Of The Provider | 100296500 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | CRNA |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 157 |
| Number Of Medicare Beneficiaries | 155 |
| Total Submitted Charge Amount | 146332 |
| Total Medicare Allowed Amount | 20927.26 |
| Total Medicare Payment Amount | 16458.24 |
| Total Medicare Standardized Payment Amount | 14886.45 |
| 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 | 24 |
| Number Of Medical Services | 157 |
| Number Of Medicare Beneficiaries With Medical Services | 155 |
| Total Medical Submitted Charge Amount | 146332 |
| Total Medical Medicare Allowed Amount | 20927.26 |
| Total Medical Medicare Payment Amount | 16458.24 |
| Total Medical Medicare Standardized Payment Amount | 14886.45 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 48 |
| Number Of Beneficiaries Age 65 to 74 | 59 |
| Number Of Beneficiaries Age 75 to 84 | 34 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 86 |
| Number Of Male Beneficiaries | 69 |
| Number Of Non Hispanic White Beneficiaries | 83 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 33 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 91 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 64 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 37 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.3155 |