| National Provider Identifier [NPI]: | 1912972415 |
| Last Name Of The Provider | KOUTRELAKOS |
| First Name Of The Provider | NICHOLAS |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10710 CHARTER DR |
| Street Address 2 Of The Provider | SUITE G020 |
| City Of The Provider | COLUMBIA |
| Zip Code Of The Provider | 210443128 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Medical Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 121 |
| Number Of Services | 245108 |
| Number Of Medicare Beneficiaries | 508 |
| Total Submitted Charge Amount | 8331806 |
| Total Medicare Allowed Amount | 2328727.28 |
| Total Medicare Payment Amount | 1800474.18 |
| Total Medicare Standardized Payment Amount | 1779047.88 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 66 |
| Number Of Drug Services | 236264 |
| Number Of Medicare Beneficiaries With Drug Services | 171 |
| Total Drug Submitted ChargeAmount | 7093307 |
| Total Drug Medicare AllowedAmount | 1955400.63 |
| Total Drug Medicare PaymentAmount | 1507097.65 |
| Total Drug Medicare Standardized Payment Amount | 1507097.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 55 |
| Number Of Medical Services | 8844 |
| Number Of Medicare Beneficiaries With Medical Services | 508 |
| Total Medical Submitted Charge Amount | 1238499 |
| Total Medical Medicare Allowed Amount | 373326.65 |
| Total Medical Medicare Payment Amount | 293376.53 |
| Total Medical Medicare Standardized Payment Amount | 271950.23 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 30 |
| Number Of Beneficiaries Age 65 to 74 | 228 |
| Number Of Beneficiaries Age 75 to 84 | 194 |
| Number Of Beneficiaries Age Greater 84 | 56 |
| Number Of Female Beneficiaries | 302 |
| Number Of Male Beneficiaries | 206 |
| Number Of Non Hispanic White Beneficiaries | 403 |
| Number Of Black or African American Beneficiaries | 66 |
| Number Of AsianPacific Islander Beneficiaries | 25 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 461 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 47 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 50 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 31 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.6373 |