| National Provider Identifier [NPI]: | 1154300622 |
| Last Name Of The Provider | DACOSTA |
| First Name Of The Provider | NOSHIR |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 48 ROUTE 25A |
| Street Address 2 Of The Provider | SUITE 209 |
| 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 | Medical Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 191 |
| Number Of Services | 193095 |
| Number Of Medicare Beneficiaries | 1361 |
| Total Submitted Charge Amount | 5866522.11 |
| Total Medicare Allowed Amount | 2966504.42 |
| Total Medicare Payment Amount | 2329408.56 |
| Total Medicare Standardized Payment Amount | 2257999.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 84 |
| Number Of Drug Services | 168713 |
| Number Of Medicare Beneficiaries With Drug Services | 451 |
| Total Drug Submitted ChargeAmount | 3528723.61 |
| Total Drug Medicare AllowedAmount | 1912517.41 |
| Total Drug Medicare PaymentAmount | 1496169.41 |
| Total Drug Medicare Standardized Payment Amount | 1496169.41 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 107 |
| Number Of Medical Services | 24382 |
| Number Of Medicare Beneficiaries With Medical Services | 1361 |
| Total Medical Submitted Charge Amount | 2337798.5 |
| Total Medical Medicare Allowed Amount | 1053987.01 |
| Total Medical Medicare Payment Amount | 833239.15 |
| Total Medical Medicare Standardized Payment Amount | 761829.71 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 146 |
| Number Of Beneficiaries Age 65 to 74 | 553 |
| Number Of Beneficiaries Age 75 to 84 | 459 |
| Number Of Beneficiaries Age Greater 84 | 203 |
| Number Of Female Beneficiaries | 842 |
| Number Of Male Beneficiaries | 519 |
| Number Of Non Hispanic White Beneficiaries | 1247 |
| Number Of Black or African American Beneficiaries | 33 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 39 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 22 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1170 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 191 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 44 |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 42 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.9879 |