| National Provider Identifier [NPI]: | 1346680519 |
| Last Name Of The Provider | SMIRNOV |
| First Name Of The Provider | KSENIA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | CRNP |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9880 BUSTLETON AVE |
| Street Address 2 Of The Provider | SUITE 208 |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191152185 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 5286 |
| Number Of Medicare Beneficiaries | 649 |
| Total Submitted Charge Amount | 565065 |
| Total Medicare Allowed Amount | 208221.56 |
| Total Medicare Payment Amount | 156340.03 |
| Total Medicare Standardized Payment Amount | 168848.15 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 1175 |
| Number Of Medicare Beneficiaries With Drug Services | 30 |
| Total Drug Submitted ChargeAmount | 110975 |
| Total Drug Medicare AllowedAmount | 30775.82 |
| Total Drug Medicare PaymentAmount | 23706.98 |
| Total Drug Medicare Standardized Payment Amount | 23706.98 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 29 |
| Number Of Medical Services | 4111 |
| Number Of Medicare Beneficiaries With Medical Services | 649 |
| Total Medical Submitted Charge Amount | 454090 |
| Total Medical Medicare Allowed Amount | 177445.74 |
| Total Medical Medicare Payment Amount | 132633.05 |
| Total Medical Medicare Standardized Payment Amount | 145141.17 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 52 |
| Number Of Beneficiaries Age 65 to 74 | 213 |
| Number Of Beneficiaries Age 75 to 84 | 282 |
| Number Of Beneficiaries Age Greater 84 | 102 |
| Number Of Female Beneficiaries | 221 |
| Number Of Male Beneficiaries | 428 |
| Number Of Non Hispanic White Beneficiaries | 507 |
| Number Of Black or African American Beneficiaries | 81 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 44 |
| Number Of Beneficiaries With Medicare Only Entitlement | 124 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 525 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 20 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 58 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 71 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 61 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.6058 |