| National Provider Identifier [NPI]: | 1689797847 |
| Last Name Of The Provider | MIROVSKI |
| First Name Of The Provider | MAXIM |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 400 GRESHAM DR |
| Street Address 2 Of The Provider | 907 MEDICAL TOWER |
| City Of The Provider | NORFOLK |
| Zip Code Of The Provider | 235071901 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nephrology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 30 |
| Number Of Services | 4742 |
| Number Of Medicare Beneficiaries | 761 |
| Total Submitted Charge Amount | 666065 |
| Total Medicare Allowed Amount | 415552.01 |
| Total Medicare Payment Amount | 319130.82 |
| Total Medicare Standardized Payment Amount | 324279.46 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1947 |
| Number Of Medicare Beneficiaries With Drug Services | 23 |
| Total Drug Submitted ChargeAmount | 29345 |
| Total Drug Medicare AllowedAmount | 22350.08 |
| Total Drug Medicare PaymentAmount | 17178.7 |
| Total Drug Medicare Standardized Payment Amount | 17178.7 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 28 |
| Number Of Medical Services | 2795 |
| Number Of Medicare Beneficiaries With Medical Services | 761 |
| Total Medical Submitted Charge Amount | 636720 |
| Total Medical Medicare Allowed Amount | 393201.93 |
| Total Medical Medicare Payment Amount | 301952.12 |
| Total Medical Medicare Standardized Payment Amount | 307100.76 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 201 |
| Number Of Beneficiaries Age 65 to 74 | 228 |
| Number Of Beneficiaries Age 75 to 84 | 233 |
| Number Of Beneficiaries Age Greater 84 | 99 |
| Number Of Female Beneficiaries | 381 |
| Number Of Male Beneficiaries | 380 |
| Number Of Non Hispanic White Beneficiaries | 318 |
| Number Of Black or African American Beneficiaries | 400 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 22 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 468 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 293 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 61 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 67 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 4.0376 |