| National Provider Identifier [NPI]: | 1467788703 |
| Last Name Of The Provider | SIMON |
| First Name Of The Provider | ELIZABETH |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6045 KENNEDY BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | NORTH BERGEN |
| Zip Code Of The Provider | 070473246 |
| State Code Of The Provider | NJ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 50 |
| Number Of Services | 2816 |
| Number Of Medicare Beneficiaries | 472 |
| Total Submitted Charge Amount | 526720 |
| Total Medicare Allowed Amount | 220414.48 |
| Total Medicare Payment Amount | 165497.68 |
| Total Medicare Standardized Payment Amount | 149822.81 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 64 |
| Number Of Medicare Beneficiaries With Drug Services | 49 |
| Total Drug Submitted ChargeAmount | 3145 |
| Total Drug Medicare AllowedAmount | 1005.18 |
| Total Drug Medicare PaymentAmount | 978.86 |
| Total Drug Medicare Standardized Payment Amount | 978.86 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 39 |
| Number Of Medical Services | 2752 |
| Number Of Medicare Beneficiaries With Medical Services | 472 |
| Total Medical Submitted Charge Amount | 523575 |
| Total Medical Medicare Allowed Amount | 219409.3 |
| Total Medical Medicare Payment Amount | 164518.82 |
| Total Medical Medicare Standardized Payment Amount | 148843.95 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 52 |
| Number Of Beneficiaries Age 65 to 74 | 135 |
| Number Of Beneficiaries Age 75 to 84 | 163 |
| Number Of Beneficiaries Age Greater 84 | 122 |
| Number Of Female Beneficiaries | 309 |
| Number Of Male Beneficiaries | 163 |
| Number Of Non Hispanic White Beneficiaries | 107 |
| Number Of Black or African American Beneficiaries | 14 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 337 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 160 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 312 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 45 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 38 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 63 |
| Percent Of With Hyperlipidemia | 71 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 60 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.8674 |