| National Provider Identifier [NPI]: | 1427159276 |
| Last Name Of The Provider | KHOLDAROVA |
| First Name Of The Provider | LYUDMILA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 48 ROUTE 25A |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | SMITHTOWN |
| Zip Code Of The Provider | 117871431 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Anesthesiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 290 |
| Number Of Medicare Beneficiaries | 260 |
| Total Submitted Charge Amount | 393249.6 |
| Total Medicare Allowed Amount | 42186.52 |
| Total Medicare Payment Amount | 32312.81 |
| Total Medicare Standardized Payment Amount | 28201.83 |
| 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 | 54 |
| Number Of Medical Services | 290 |
| Number Of Medicare Beneficiaries With Medical Services | 260 |
| Total Medical Submitted Charge Amount | 393249.6 |
| Total Medical Medicare Allowed Amount | 42186.52 |
| Total Medical Medicare Payment Amount | 32312.81 |
| Total Medical Medicare Standardized Payment Amount | 28201.83 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 55 |
| Number Of Beneficiaries Age 65 to 74 | 95 |
| Number Of Beneficiaries Age 75 to 84 | 75 |
| Number Of Beneficiaries Age Greater 84 | 35 |
| Number Of Female Beneficiaries | 119 |
| Number Of Male Beneficiaries | 141 |
| Number Of Non Hispanic White Beneficiaries | 120 |
| Number Of Black or African American Beneficiaries | 98 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 28 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 50 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 210 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 51 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 48 |
| Percent Of With Chronic Kidney Disease | 58 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 70 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 71 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 36 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 3.2876 |