| National Provider Identifier [NPI]: | 1073567186 |
| Last Name Of The Provider | DEROVANESIAN |
| First Name Of The Provider | JACK |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6400 DAVIS BLVD STE 103 |
| Street Address 2 Of The Provider | |
| City Of The Provider | NAPLES |
| Zip Code Of The Provider | 341045321 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 92 |
| Number Of Services | 2697 |
| Number Of Medicare Beneficiaries | 1310 |
| Total Submitted Charge Amount | 478183.02 |
| Total Medicare Allowed Amount | 202309.11 |
| Total Medicare Payment Amount | 134159.37 |
| Total Medicare Standardized Payment Amount | 129859.76 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 166 |
| Number Of Medicare Beneficiaries With Drug Services | 89 |
| Total Drug Submitted ChargeAmount | 3623 |
| Total Drug Medicare AllowedAmount | 1007.74 |
| Total Drug Medicare PaymentAmount | 766.46 |
| Total Drug Medicare Standardized Payment Amount | 766.46 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 80 |
| Number Of Medical Services | 2531 |
| Number Of Medicare Beneficiaries With Medical Services | 1310 |
| Total Medical Submitted Charge Amount | 474560.02 |
| Total Medical Medicare Allowed Amount | 201301.37 |
| Total Medical Medicare Payment Amount | 133392.91 |
| Total Medical Medicare Standardized Payment Amount | 129093.3 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 35 |
| Number Of Beneficiaries Age 65 to 74 | 551 |
| Number Of Beneficiaries Age 75 to 84 | 525 |
| Number Of Beneficiaries Age Greater 84 | 199 |
| Number Of Female Beneficiaries | 784 |
| Number Of Male Beneficiaries | 526 |
| Number Of Non Hispanic White Beneficiaries | 1287 |
| 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 | 11 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1281 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 29 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0092 |