| National Provider Identifier [NPI]: | 1861572703 |
| Last Name Of The Provider | KLEBANOV |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 120 LA CASA VIA STE 102 |
| Street Address 2 Of The Provider | |
| City Of The Provider | WALNUT CREEK |
| Zip Code Of The Provider | 945983092 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 53 |
| Number Of Services | 4550 |
| Number Of Medicare Beneficiaries | 474 |
| Total Submitted Charge Amount | 450181 |
| Total Medicare Allowed Amount | 374381.38 |
| Total Medicare Payment Amount | 294590.76 |
| Total Medicare Standardized Payment Amount | 261135.11 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 228 |
| Number Of Medicare Beneficiaries With Drug Services | 180 |
| Total Drug Submitted ChargeAmount | 14015 |
| Total Drug Medicare AllowedAmount | 9850.34 |
| Total Drug Medicare PaymentAmount | 9652.71 |
| Total Drug Medicare Standardized Payment Amount | 9652.71 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 51 |
| Number Of Medical Services | 4322 |
| Number Of Medicare Beneficiaries With Medical Services | 474 |
| Total Medical Submitted Charge Amount | 436166 |
| Total Medical Medicare Allowed Amount | 364531.04 |
| Total Medical Medicare Payment Amount | 284938.05 |
| Total Medical Medicare Standardized Payment Amount | 251482.4 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 12 |
| Number Of Beneficiaries Age 65 to 74 | 180 |
| Number Of Beneficiaries Age 75 to 84 | 188 |
| Number Of Beneficiaries Age Greater 84 | 94 |
| Number Of Female Beneficiaries | 281 |
| Number Of Male Beneficiaries | 193 |
| Number Of Non Hispanic White Beneficiaries | 416 |
| 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 | 36 |
| Number Of Beneficiaries With Medicare Only Entitlement | 177 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 297 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 47 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.3991 |