| National Provider Identifier [NPI]: | 1609851617 |
| Last Name Of The Provider | AVSHALOMOV |
| First Name Of The Provider | GADI |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7001 AVENUE U |
| Street Address 2 Of The Provider | |
| City Of The Provider | BROOKLYN |
| Zip Code Of The Provider | 112346117 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Allergy/Immunology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 39 |
| Number Of Services | 18755 |
| Number Of Medicare Beneficiaries | 223 |
| Total Submitted Charge Amount | 983299.5 |
| Total Medicare Allowed Amount | 318138.95 |
| Total Medicare Payment Amount | 245050.07 |
| Total Medicare Standardized Payment Amount | 198678.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 696 |
| Number Of Medicare Beneficiaries With Drug Services | 86 |
| Total Drug Submitted ChargeAmount | 68124 |
| Total Drug Medicare AllowedAmount | 28206.65 |
| Total Drug Medicare PaymentAmount | 23160.6 |
| Total Drug Medicare Standardized Payment Amount | 23160.6 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 18059 |
| Number Of Medicare Beneficiaries With Medical Services | 223 |
| Total Medical Submitted Charge Amount | 915175.5 |
| Total Medical Medicare Allowed Amount | 289932.3 |
| Total Medical Medicare Payment Amount | 221889.47 |
| Total Medical Medicare Standardized Payment Amount | 175517.66 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 129 |
| Number Of Beneficiaries Age 75 to 84 | 57 |
| Number Of Beneficiaries Age Greater 84 | 12 |
| Number Of Female Beneficiaries | 137 |
| Number Of Male Beneficiaries | 86 |
| Number Of Non Hispanic White Beneficiaries | 180 |
| Number Of Black or African American Beneficiaries | 16 |
| 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 | 14 |
| Number Of Beneficiaries With Medicare Only Entitlement | 201 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 22 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 39 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.253 |