| National Provider Identifier [NPI]: | 1588762231 |
| Last Name Of The Provider | BANIN |
| First Name Of The Provider | GELENA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | O.D |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11685 BUSTLETON AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191162542 |
| 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 | 5 |
| Number Of Services | 5317 |
| Number Of Medicare Beneficiaries | 837 |
| Total Submitted Charge Amount | 691940 |
| Total Medicare Allowed Amount | 364780.96 |
| Total Medicare Payment Amount | 284939.73 |
| Total Medicare Standardized Payment Amount | 270846.43 |
| 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 | 5 |
| Number Of Medical Services | 5317 |
| Number Of Medicare Beneficiaries With Medical Services | 837 |
| Total Medical Submitted Charge Amount | 691940 |
| Total Medical Medicare Allowed Amount | 364780.96 |
| Total Medical Medicare Payment Amount | 284939.73 |
| Total Medical Medicare Standardized Payment Amount | 270846.43 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 41 |
| Number Of Beneficiaries Age 65 to 74 | 346 |
| Number Of Beneficiaries Age 75 to 84 | 362 |
| Number Of Beneficiaries Age Greater 84 | 88 |
| Number Of Female Beneficiaries | 502 |
| Number Of Male Beneficiaries | 335 |
| Number Of Non Hispanic White Beneficiaries | 756 |
| Number Of Black or African American Beneficiaries | |
| 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 | 60 |
| Number Of Beneficiaries With Medicare Only Entitlement | 62 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 775 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 57 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 74 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 68 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.4292 |