| National Provider Identifier [NPI]: | 1528054368 |
| Last Name Of The Provider | ANTONEVICH |
| First Name Of The Provider | TATYANA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1729 BURRSTONE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | NEW HARTFORD |
| Zip Code Of The Provider | 134131001 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pulmonary Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 33 |
| Number Of Services | 4153 |
| Number Of Medicare Beneficiaries | 898 |
| Total Submitted Charge Amount | 573546.12 |
| Total Medicare Allowed Amount | 316926.37 |
| Total Medicare Payment Amount | 236384.85 |
| Total Medicare Standardized Payment Amount | 253555.05 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1177 |
| Number Of Medicare Beneficiaries With Drug Services | 382 |
| Total Drug Submitted ChargeAmount | 1213.85 |
| Total Drug Medicare AllowedAmount | 456.59 |
| Total Drug Medicare PaymentAmount | 433.41 |
| Total Drug Medicare Standardized Payment Amount | 433.41 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 2976 |
| Number Of Medicare Beneficiaries With Medical Services | 898 |
| Total Medical Submitted Charge Amount | 572332.27 |
| Total Medical Medicare Allowed Amount | 316469.78 |
| Total Medical Medicare Payment Amount | 235951.44 |
| Total Medical Medicare Standardized Payment Amount | 253121.64 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 191 |
| Number Of Beneficiaries Age 65 to 74 | 342 |
| Number Of Beneficiaries Age 75 to 84 | 265 |
| Number Of Beneficiaries Age Greater 84 | 100 |
| Number Of Female Beneficiaries | 519 |
| Number Of Male Beneficiaries | 379 |
| Number Of Non Hispanic White Beneficiaries | 814 |
| Number Of Black or African American Beneficiaries | 42 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 18 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 645 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 253 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 22 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 57 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.6976 |