| National Provider Identifier [NPI]: | 1902001514 |
| Last Name Of The Provider | DEMICCO |
| First Name Of The Provider | ELIZABETH |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD, PHD. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1 GUSTAVE L LEVY PL |
| Street Address 2 Of The Provider | DEPARTMENT OF PATHOLOGY |
| City Of The Provider | NEW YORK |
| Zip Code Of The Provider | 100296500 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pathology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 2113 |
| Number Of Medicare Beneficiaries | 821 |
| Total Submitted Charge Amount | 365113 |
| Total Medicare Allowed Amount | 87878.45 |
| Total Medicare Payment Amount | 68754.25 |
| Total Medicare Standardized Payment Amount | 57037.65 |
| 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 | 18 |
| Number Of Medical Services | 2113 |
| Number Of Medicare Beneficiaries With Medical Services | 821 |
| Total Medical Submitted Charge Amount | 365113 |
| Total Medical Medicare Allowed Amount | 87878.45 |
| Total Medical Medicare Payment Amount | 68754.25 |
| Total Medical Medicare Standardized Payment Amount | 57037.65 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 128 |
| Number Of Beneficiaries Age 65 to 74 | 365 |
| Number Of Beneficiaries Age 75 to 84 | 252 |
| Number Of Beneficiaries Age Greater 84 | 76 |
| Number Of Female Beneficiaries | 443 |
| Number Of Male Beneficiaries | 378 |
| Number Of Non Hispanic White Beneficiaries | 578 |
| Number Of Black or African American Beneficiaries | 89 |
| Number Of AsianPacific Islander Beneficiaries | 30 |
| Number Of Hispanic Beneficiaries | 102 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 597 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 224 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.7774 |