| National Provider Identifier [NPI]: | 1588673909 |
| Last Name Of The Provider | KOVANKO |
| First Name Of The Provider | ALEXANDER |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 44 BIRCH ST |
| Street Address 2 Of The Provider | SUITE 200 |
| City Of The Provider | DERRY |
| Zip Code Of The Provider | 030382752 |
| State Code Of The Provider | NH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 893 |
| Number Of Medicare Beneficiaries | 215 |
| Total Submitted Charge Amount | 104993 |
| Total Medicare Allowed Amount | 48570.39 |
| Total Medicare Payment Amount | 36913.58 |
| Total Medicare Standardized Payment Amount | 36451.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 279 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 6581 |
| Total Drug Medicare AllowedAmount | 4089.48 |
| Total Drug Medicare PaymentAmount | 3326.77 |
| Total Drug Medicare Standardized Payment Amount | 3326.77 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 614 |
| Number Of Medicare Beneficiaries With Medical Services | 215 |
| Total Medical Submitted Charge Amount | 98412 |
| Total Medical Medicare Allowed Amount | 44480.91 |
| Total Medical Medicare Payment Amount | 33586.81 |
| Total Medical Medicare Standardized Payment Amount | 33125.21 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 72 |
| Number Of Beneficiaries Age 65 to 74 | 78 |
| Number Of Beneficiaries Age 75 to 84 | 47 |
| Number Of Beneficiaries Age Greater 84 | 18 |
| Number Of Female Beneficiaries | 121 |
| Number Of Male Beneficiaries | 94 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 146 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 69 |
| Percent Of With Atrial Fibrillation | 20 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 27 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2744 |