| National Provider Identifier [NPI]: | 1578558714 |
| Last Name Of The Provider | GEDEVANISHVILI |
| First Name Of The Provider | ALEXANDER |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1551 DOCTORS DR |
| Street Address 2 Of The Provider | BUILDING 200 |
| City Of The Provider | LAGRANGE |
| Zip Code Of The Provider | 302404139 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 58 |
| Number Of Services | 5747 |
| Number Of Medicare Beneficiaries | 1110 |
| Total Submitted Charge Amount | 888344.51 |
| Total Medicare Allowed Amount | 339433.89 |
| Total Medicare Payment Amount | 259560.35 |
| Total Medicare Standardized Payment Amount | 274218.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 126 |
| Number Of Medicare Beneficiaries With Drug Services | 33 |
| Total Drug Submitted ChargeAmount | 9450 |
| Total Drug Medicare AllowedAmount | 6675.6 |
| Total Drug Medicare PaymentAmount | 5233.62 |
| Total Drug Medicare Standardized Payment Amount | 5233.62 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 57 |
| Number Of Medical Services | 5621 |
| Number Of Medicare Beneficiaries With Medical Services | 1110 |
| Total Medical Submitted Charge Amount | 878894.51 |
| Total Medical Medicare Allowed Amount | 332758.29 |
| Total Medical Medicare Payment Amount | 254326.73 |
| Total Medical Medicare Standardized Payment Amount | 268984.65 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 206 |
| Number Of Beneficiaries Age 65 to 74 | 386 |
| Number Of Beneficiaries Age 75 to 84 | 347 |
| Number Of Beneficiaries Age Greater 84 | 171 |
| Number Of Female Beneficiaries | 600 |
| Number Of Male Beneficiaries | 510 |
| Number Of Non Hispanic White Beneficiaries | 821 |
| Number Of Black or African American Beneficiaries | 262 |
| 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 | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 779 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 331 |
| Percent Of With Atrial Fibrillation | 29 |
| Percent Of With Alzheimers Disease or Dementia | 18 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 47 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 50 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 57 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.7755 |