| National Provider Identifier [NPI]: | 1104828706 |
| Last Name Of The Provider | NOVACK |
| First Name Of The Provider | ROGER |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1127 WILSHIRE BLVD |
| Street Address 2 Of The Provider | #1620 |
| City Of The Provider | LOS ANGELES |
| Zip Code Of The Provider | 900173901 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 52 |
| Number Of Services | 11131 |
| Number Of Medicare Beneficiaries | 1216 |
| Total Submitted Charge Amount | 4866026.05 |
| Total Medicare Allowed Amount | 2001184.43 |
| Total Medicare Payment Amount | 1531585.75 |
| Total Medicare Standardized Payment Amount | 1484743.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 3585 |
| Number Of Medicare Beneficiaries With Drug Services | 285 |
| Total Drug Submitted ChargeAmount | 2835030.05 |
| Total Drug Medicare AllowedAmount | 1256131.3 |
| Total Drug Medicare PaymentAmount | 983553.21 |
| Total Drug Medicare Standardized Payment Amount | 983553.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 7546 |
| Number Of Medicare Beneficiaries With Medical Services | 1215 |
| Total Medical Submitted Charge Amount | 2030996 |
| Total Medical Medicare Allowed Amount | 745053.13 |
| Total Medical Medicare Payment Amount | 548032.54 |
| Total Medical Medicare Standardized Payment Amount | 501190.34 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 136 |
| Number Of Beneficiaries Age 65 to 74 | 418 |
| Number Of Beneficiaries Age 75 to 84 | 401 |
| Number Of Beneficiaries Age Greater 84 | 261 |
| Number Of Female Beneficiaries | 688 |
| Number Of Male Beneficiaries | 528 |
| Number Of Non Hispanic White Beneficiaries | 753 |
| Number Of Black or African American Beneficiaries | 73 |
| Number Of AsianPacific Islander Beneficiaries | 93 |
| Number Of Hispanic Beneficiaries | 266 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 748 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 468 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.8322 |