| National Provider Identifier [NPI]: | 1386615201 |
| Last Name Of The Provider | EBRAHIM |
| First Name Of The Provider | KURT |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2 INDEPENDENCE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | KENNEBUNK |
| Zip Code Of The Provider | 040436078 |
| State Code Of The Provider | ME |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 161 |
| Number Of Services | 191319 |
| Number Of Medicare Beneficiaries | 671 |
| Total Submitted Charge Amount | 4978003.68 |
| Total Medicare Allowed Amount | 2906357.37 |
| Total Medicare Payment Amount | 2265772.7 |
| Total Medicare Standardized Payment Amount | 2256271.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 69 |
| Number Of Drug Services | 177846 |
| Number Of Medicare Beneficiaries With Drug Services | 199 |
| Total Drug Submitted ChargeAmount | 3612116.51 |
| Total Drug Medicare AllowedAmount | 2326448.16 |
| Total Drug Medicare PaymentAmount | 1810776.29 |
| Total Drug Medicare Standardized Payment Amount | 1810776.29 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 92 |
| Number Of Medical Services | 13473 |
| Number Of Medicare Beneficiaries With Medical Services | 671 |
| Total Medical Submitted Charge Amount | 1365887.17 |
| Total Medical Medicare Allowed Amount | 579909.21 |
| Total Medical Medicare Payment Amount | 454996.41 |
| Total Medical Medicare Standardized Payment Amount | 445494.97 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 109 |
| Number Of Beneficiaries Age 65 to 74 | 243 |
| Number Of Beneficiaries Age 75 to 84 | 218 |
| Number Of Beneficiaries Age Greater 84 | 101 |
| Number Of Female Beneficiaries | 382 |
| Number Of Male Beneficiaries | 289 |
| Number Of Non Hispanic White Beneficiaries | 650 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 421 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 250 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 45 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 35 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.8763 |