| National Provider Identifier [NPI]: | 1982649836 |
| Last Name Of The Provider | TIKHOMIROV |
| First Name Of The Provider | VADIM |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 95 LOCUST AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | DANBURY |
| Zip Code Of The Provider | 068106148 |
| State Code Of The Provider | CT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 2369 |
| Number Of Medicare Beneficiaries | 589 |
| Total Submitted Charge Amount | 430211 |
| Total Medicare Allowed Amount | 221289.87 |
| Total Medicare Payment Amount | 158690.18 |
| Total Medicare Standardized Payment Amount | 151166.13 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 119 |
| Number Of Medicare Beneficiaries With Drug Services | 74 |
| Total Drug Submitted ChargeAmount | 2831 |
| Total Drug Medicare AllowedAmount | 1563.67 |
| Total Drug Medicare PaymentAmount | 1483.03 |
| Total Drug Medicare Standardized Payment Amount | 1483.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 2250 |
| Number Of Medicare Beneficiaries With Medical Services | 589 |
| Total Medical Submitted Charge Amount | 427380 |
| Total Medical Medicare Allowed Amount | 219726.2 |
| Total Medical Medicare Payment Amount | 157207.15 |
| Total Medical Medicare Standardized Payment Amount | 149683.1 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 73 |
| Number Of Beneficiaries Age 65 to 74 | 226 |
| Number Of Beneficiaries Age 75 to 84 | 195 |
| Number Of Beneficiaries Age Greater 84 | 95 |
| Number Of Female Beneficiaries | 265 |
| Number Of Male Beneficiaries | 324 |
| Number Of Non Hispanic White Beneficiaries | 530 |
| Number Of Black or African American Beneficiaries | 12 |
| Number Of AsianPacific Islander Beneficiaries | 14 |
| Number Of Hispanic Beneficiaries | 18 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 15 |
| Number Of Beneficiaries With Medicare Only Entitlement | 448 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 141 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.3477 |