| National Provider Identifier [NPI]: | 1164637153 |
| Last Name Of The Provider | DELENGOCKY |
| First Name Of The Provider | TAYSON |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.O |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 835 3RD AVE |
| Street Address 2 Of The Provider | SUITE A |
| City Of The Provider | CHULA VISTA |
| Zip Code Of The Provider | 919111352 |
| 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 | 50 |
| Number Of Services | 10210 |
| Number Of Medicare Beneficiaries | 1805 |
| Total Submitted Charge Amount | 2315580 |
| Total Medicare Allowed Amount | 1181139.55 |
| Total Medicare Payment Amount | 886788.98 |
| Total Medicare Standardized Payment Amount | 843080.92 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 365 |
| Number Of Medicare Beneficiaries With Drug Services | 100 |
| Total Drug Submitted ChargeAmount | 38130 |
| Total Drug Medicare AllowedAmount | 17569.92 |
| Total Drug Medicare PaymentAmount | 13674.67 |
| Total Drug Medicare Standardized Payment Amount | 13674.67 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 46 |
| Number Of Medical Services | 9845 |
| Number Of Medicare Beneficiaries With Medical Services | 1805 |
| Total Medical Submitted Charge Amount | 2277450 |
| Total Medical Medicare Allowed Amount | 1163569.63 |
| Total Medical Medicare Payment Amount | 873114.31 |
| Total Medical Medicare Standardized Payment Amount | 829406.25 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 336 |
| Number Of Beneficiaries Age 65 to 74 | 788 |
| Number Of Beneficiaries Age 75 to 84 | 487 |
| Number Of Beneficiaries Age Greater 84 | 194 |
| Number Of Female Beneficiaries | 1000 |
| Number Of Male Beneficiaries | 805 |
| Number Of Non Hispanic White Beneficiaries | 151 |
| Number Of Black or African American Beneficiaries | 30 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 1599 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 312 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1493 |
| Percent Of With Atrial Fibrillation | 6 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 65 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.5773 |