| National Provider Identifier [NPI]: | 1194807172 |
| Last Name Of The Provider | PADOUSIS |
| First Name Of The Provider | JEFFREY |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 522 N NEW BALLAS RD |
| Street Address 2 Of The Provider | STE 136 |
| City Of The Provider | SAINT LOUIS |
| Zip Code Of The Provider | 631416857 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 22 |
| Number Of Services | 1539 |
| Number Of Medicare Beneficiaries | 829 |
| Total Submitted Charge Amount | 583767 |
| Total Medicare Allowed Amount | 223766.59 |
| Total Medicare Payment Amount | 153712.63 |
| Total Medicare Standardized Payment Amount | 158392.98 |
| 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 | 22 |
| Number Of Medical Services | 1539 |
| Number Of Medicare Beneficiaries With Medical Services | 829 |
| Total Medical Submitted Charge Amount | 583767 |
| Total Medical Medicare Allowed Amount | 223766.59 |
| Total Medical Medicare Payment Amount | 153712.63 |
| Total Medical Medicare Standardized Payment Amount | 158392.98 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 43 |
| Number Of Beneficiaries Age 65 to 74 | 427 |
| Number Of Beneficiaries Age 75 to 84 | 270 |
| Number Of Beneficiaries Age Greater 84 | 89 |
| Number Of Female Beneficiaries | 499 |
| Number Of Male Beneficiaries | 330 |
| Number Of Non Hispanic White Beneficiaries | 779 |
| Number Of Black or African American Beneficiaries | 30 |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0506 |