| National Provider Identifier [NPI]: | 1134148042 |
| Last Name Of The Provider | BENENSON |
| First Name Of The Provider | IGOR |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | D.O |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9892 BUSTLETON AVE |
| Street Address 2 Of The Provider | SUITE 306 |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191152184 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 2880 |
| Number Of Medicare Beneficiaries | 1201 |
| Total Submitted Charge Amount | 623395 |
| Total Medicare Allowed Amount | 395997.3 |
| Total Medicare Payment Amount | 285751.24 |
| Total Medicare Standardized Payment Amount | 266796.26 |
| 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 | 34 |
| Number Of Medical Services | 2880 |
| Number Of Medicare Beneficiaries With Medical Services | 1201 |
| Total Medical Submitted Charge Amount | 623395 |
| Total Medical Medicare Allowed Amount | 395997.3 |
| Total Medical Medicare Payment Amount | 285751.24 |
| Total Medical Medicare Standardized Payment Amount | 266796.26 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 51 |
| Number Of Beneficiaries Age 65 to 74 | 381 |
| Number Of Beneficiaries Age 75 to 84 | 557 |
| Number Of Beneficiaries Age Greater 84 | 212 |
| Number Of Female Beneficiaries | 750 |
| Number Of Male Beneficiaries | 451 |
| Number Of Non Hispanic White Beneficiaries | 1086 |
| Number Of Black or African American Beneficiaries | |
| 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 | 97 |
| Number Of Beneficiaries With Medicare Only Entitlement | 100 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 1101 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 59 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 67 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.531 |