| National Provider Identifier [NPI]: | 1255319646 |
| Last Name Of The Provider | KISLAN |
| First Name Of The Provider | THOMAS |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | O.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 852 N 9TH ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | STROUDSBURG |
| Zip Code Of The Provider | 183601206 |
| 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 | 39 |
| Number Of Services | 8482 |
| Number Of Medicare Beneficiaries | 895 |
| Total Submitted Charge Amount | 745126.88 |
| Total Medicare Allowed Amount | 588858.33 |
| Total Medicare Payment Amount | 449157.25 |
| Total Medicare Standardized Payment Amount | 495166.71 |
| 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 | 39 |
| Number Of Medical Services | 8482 |
| Number Of Medicare Beneficiaries With Medical Services | 895 |
| Total Medical Submitted Charge Amount | 745126.88 |
| Total Medical Medicare Allowed Amount | 588858.33 |
| Total Medical Medicare Payment Amount | 449157.25 |
| Total Medical Medicare Standardized Payment Amount | 495166.71 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 67 |
| Number Of Beneficiaries Age 65 to 74 | 363 |
| Number Of Beneficiaries Age 75 to 84 | 306 |
| Number Of Beneficiaries Age Greater 84 | 159 |
| Number Of Female Beneficiaries | 547 |
| Number Of Male Beneficiaries | 348 |
| Number Of Non Hispanic White Beneficiaries | 852 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 814 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 81 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 67 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.1367 |