| National Provider Identifier [NPI]: | 1134192891 |
| Last Name Of The Provider | LICHT |
| First Name Of The Provider | JONAH |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 100 HIGHLAND AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | PROVIDENCE |
| Zip Code Of The Provider | 029062740 |
| State Code Of The Provider | RI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 53 |
| Number Of Services | 70697 |
| Number Of Medicare Beneficiaries | 723 |
| Total Submitted Charge Amount | 11115050 |
| Total Medicare Allowed Amount | 3673974.48 |
| Total Medicare Payment Amount | 2842778.3 |
| Total Medicare Standardized Payment Amount | 2741302.47 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 66061 |
| Number Of Medicare Beneficiaries With Drug Services | 630 |
| Total Drug Submitted ChargeAmount | 73452 |
| Total Drug Medicare AllowedAmount | 19728.76 |
| Total Drug Medicare PaymentAmount | 15345.6 |
| Total Drug Medicare Standardized Payment Amount | 15345.6 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 51 |
| Number Of Medical Services | 4636 |
| Number Of Medicare Beneficiaries With Medical Services | 723 |
| Total Medical Submitted Charge Amount | 11041598 |
| Total Medical Medicare Allowed Amount | 3654245.72 |
| Total Medical Medicare Payment Amount | 2827432.7 |
| Total Medical Medicare Standardized Payment Amount | 2725956.87 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 285 |
| Number Of Beneficiaries Age 65 to 74 | 188 |
| Number Of Beneficiaries Age 75 to 84 | 168 |
| Number Of Beneficiaries Age Greater 84 | 82 |
| Number Of Female Beneficiaries | 312 |
| Number Of Male Beneficiaries | 411 |
| Number Of Non Hispanic White Beneficiaries | 489 |
| Number Of Black or African American Beneficiaries | 108 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 80 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 21 |
| Number Of Beneficiaries With Medicare Only Entitlement | 379 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 344 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 67 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 67 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 68 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 8.1995 |