| National Provider Identifier [NPI]: | 1063483469 |
| Last Name Of The Provider | LEVETAN |
| First Name Of The Provider | CLARESA |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 100 E LANCASTER AVE |
| Street Address 2 Of The Provider | 222 LANKENAU MOB SOUTH |
| City Of The Provider | WYNNEWOOD |
| Zip Code Of The Provider | 190963450 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 14 |
| Number Of Services | 781 |
| Number Of Medicare Beneficiaries | 262 |
| Total Submitted Charge Amount | 145158 |
| Total Medicare Allowed Amount | 52769.18 |
| Total Medicare Payment Amount | 38455.72 |
| Total Medicare Standardized Payment Amount | 35064.11 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 781 |
| Number Of Medicare Beneficiaries With Medical Services | 262 |
| Total Medical Submitted Charge Amount | 145158 |
| Total Medical Medicare Allowed Amount | 52769.18 |
| Total Medical Medicare Payment Amount | 38455.72 |
| Total Medical Medicare Standardized Payment Amount | 35064.11 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 68 |
| Number Of Beneficiaries Age 65 to 74 | 127 |
| Number Of Beneficiaries Age 75 to 84 | 50 |
| Number Of Beneficiaries Age Greater 84 | 17 |
| Number Of Female Beneficiaries | 191 |
| Number Of Male Beneficiaries | 71 |
| Number Of Non Hispanic White Beneficiaries | 109 |
| Number Of Black or African American Beneficiaries | 140 |
| Number Of AsianPacific Islander Beneficiaries | |
| 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 | 207 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 55 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 62 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.4213 |