| National Provider Identifier [NPI]: | 1497753784 |
| Last Name Of The Provider | LICANDRO |
| First Name Of The Provider | RUDOLPH |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3900 KRESGE WAY |
| Street Address 2 Of The Provider | STE 60 |
| City Of The Provider | LOUISVILLE |
| Zip Code Of The Provider | 402074660 |
| State Code Of The Provider | KY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 96 |
| Number Of Services | 10999 |
| Number Of Medicare Beneficiaries | 3213 |
| Total Submitted Charge Amount | 1390746 |
| Total Medicare Allowed Amount | 579168.56 |
| Total Medicare Payment Amount | 419417.76 |
| Total Medicare Standardized Payment Amount | 454883.62 |
| 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 | 96 |
| Number Of Medical Services | 10999 |
| Number Of Medicare Beneficiaries With Medical Services | 3213 |
| Total Medical Submitted Charge Amount | 1390746 |
| Total Medical Medicare Allowed Amount | 579168.56 |
| Total Medical Medicare Payment Amount | 419417.76 |
| Total Medical Medicare Standardized Payment Amount | 454883.62 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 291 |
| Number Of Beneficiaries Age 65 to 74 | 993 |
| Number Of Beneficiaries Age 75 to 84 | 1192 |
| Number Of Beneficiaries Age Greater 84 | 737 |
| Number Of Female Beneficiaries | 1626 |
| Number Of Male Beneficiaries | 1587 |
| Number Of Non Hispanic White Beneficiaries | 3054 |
| Number Of Black or African American Beneficiaries | 107 |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 25 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2792 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 421 |
| Percent Of With Atrial Fibrillation | 37 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 44 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 63 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.68 |