| National Provider Identifier [NPI]: | 1780659185 |
| Last Name Of The Provider | IVANCOVA |
| First Name Of The Provider | XENIE |
| 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 | 400 W AIRPORT BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SANFORD |
| Zip Code Of The Provider | 327735489 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 16 |
| Number Of Services | 135 |
| Number Of Medicare Beneficiaries | 44 |
| Total Submitted Charge Amount | 7343.31 |
| Total Medicare Allowed Amount | 7335.58 |
| Total Medicare Payment Amount | 5128.81 |
| Total Medicare Standardized Payment Amount | 5176.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 17 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 1414.33 |
| Total Drug Medicare AllowedAmount | 1412.53 |
| Total Drug Medicare PaymentAmount | 1185.77 |
| Total Drug Medicare Standardized Payment Amount | 1185.77 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 10 |
| Number Of Medical Services | 118 |
| Number Of Medicare Beneficiaries With Medical Services | 44 |
| Total Medical Submitted Charge Amount | 5928.98 |
| Total Medical Medicare Allowed Amount | 5923.05 |
| Total Medical Medicare Payment Amount | 3943.04 |
| Total Medical Medicare Standardized Payment Amount | 3991.21 |
| Average Age Of Beneficiaries | 55 |
| Number Of Beneficiaries Age Less65 | 33 |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | 0 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 19 |
| Number Of Male Beneficiaries | 25 |
| Number Of Non Hispanic White Beneficiaries | 11 |
| Number Of Black or African American Beneficiaries | 22 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 11 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 33 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 34 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | 0 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.7014 |