| National Provider Identifier [NPI]: | 1467456806 |
| Last Name Of The Provider | THEODORAKIS |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 235 N BELLE MEAD RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | E SETAUKET |
| Zip Code Of The Provider | 117333456 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 206 |
| Number Of Services | 165776 |
| Number Of Medicare Beneficiaries | 1445 |
| Total Submitted Charge Amount | 6114839.18 |
| Total Medicare Allowed Amount | 2929530.68 |
| Total Medicare Payment Amount | 2308137.25 |
| Total Medicare Standardized Payment Amount | 2249951.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 92 |
| Number Of Drug Services | 138876 |
| Number Of Medicare Beneficiaries With Drug Services | 553 |
| Total Drug Submitted ChargeAmount | 3220311.18 |
| Total Drug Medicare AllowedAmount | 1739451.86 |
| Total Drug Medicare PaymentAmount | 1361878.22 |
| Total Drug Medicare Standardized Payment Amount | 1361878.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 114 |
| Number Of Medical Services | 26900 |
| Number Of Medicare Beneficiaries With Medical Services | 1444 |
| Total Medical Submitted Charge Amount | 2894528 |
| Total Medical Medicare Allowed Amount | 1190078.82 |
| Total Medical Medicare Payment Amount | 946259.03 |
| Total Medical Medicare Standardized Payment Amount | 888073.46 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 153 |
| Number Of Beneficiaries Age 65 to 74 | 583 |
| Number Of Beneficiaries Age 75 to 84 | 490 |
| Number Of Beneficiaries Age Greater 84 | 219 |
| Number Of Female Beneficiaries | 898 |
| Number Of Male Beneficiaries | 547 |
| Number Of Non Hispanic White Beneficiaries | 1331 |
| Number Of Black or African American Beneficiaries | 29 |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| Number Of Hispanic Beneficiaries | 50 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1250 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 195 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 43 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 2.0298 |