| National Provider Identifier [NPI]: | 1710278445 |
| Last Name Of The Provider | PIMANOVA |
| First Name Of The Provider | ELENA |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 101 W MULBERRY BLVD |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | POOLER |
| Zip Code Of The Provider | 313223506 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 284 |
| Number Of Medicare Beneficiaries | 124 |
| Total Submitted Charge Amount | 29951 |
| Total Medicare Allowed Amount | 15176.34 |
| Total Medicare Payment Amount | 11549.46 |
| Total Medicare Standardized Payment Amount | 12479.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 24 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 1360 |
| Total Drug Medicare AllowedAmount | 459.08 |
| Total Drug Medicare PaymentAmount | 446.46 |
| Total Drug Medicare Standardized Payment Amount | 446.46 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 43 |
| Number Of Medical Services | 260 |
| Number Of Medicare Beneficiaries With Medical Services | 124 |
| Total Medical Submitted Charge Amount | 28591 |
| Total Medical Medicare Allowed Amount | 14717.26 |
| Total Medical Medicare Payment Amount | 11103 |
| Total Medical Medicare Standardized Payment Amount | 12033.12 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 14 |
| Number Of Beneficiaries Age 65 to 74 | 50 |
| Number Of Beneficiaries Age 75 to 84 | 38 |
| Number Of Beneficiaries Age Greater 84 | 22 |
| Number Of Female Beneficiaries | 66 |
| Number Of Male Beneficiaries | 58 |
| Number Of Non Hispanic White Beneficiaries | 102 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0853 |