| National Provider Identifier [NPI]: | 1740515824 |
| Last Name Of The Provider | PELIKHATYY |
| First Name Of The Provider | VITALIY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | O.D |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7101 NE 109 ST. |
| Street Address 2 Of The Provider | D-27 |
| City Of The Provider | VANCOUVER |
| Zip Code Of The Provider | 98686 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Optometry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 12 |
| Number Of Services | 1094 |
| Number Of Medicare Beneficiaries | 576 |
| Total Submitted Charge Amount | 160357 |
| Total Medicare Allowed Amount | 119114.15 |
| Total Medicare Payment Amount | 83930.9 |
| Total Medicare Standardized Payment Amount | 83340.27 |
| 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 | 12 |
| Number Of Medical Services | 1094 |
| Number Of Medicare Beneficiaries With Medical Services | 576 |
| Total Medical Submitted Charge Amount | 160357 |
| Total Medical Medicare Allowed Amount | 119114.15 |
| Total Medical Medicare Payment Amount | 83930.9 |
| Total Medical Medicare Standardized Payment Amount | 83340.27 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 118 |
| Number Of Beneficiaries Age 65 to 74 | 150 |
| Number Of Beneficiaries Age 75 to 84 | 165 |
| Number Of Beneficiaries Age Greater 84 | 143 |
| Number Of Female Beneficiaries | 345 |
| Number Of Male Beneficiaries | 231 |
| Number Of Non Hispanic White Beneficiaries | 487 |
| Number Of Black or African American Beneficiaries | 37 |
| Number Of AsianPacific Islander Beneficiaries | 23 |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 35 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 541 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 65 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 5 |
| Percent Of With Heart Failure | 65 |
| Percent Of With Chronic Kidney Disease | 52 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 47 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 36 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 28 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 28 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.9935 |