| National Provider Identifier [NPI]: | 1366410854 |
| Last Name Of The Provider | KOHUTIAK |
| First Name Of The Provider | VSEVOLOD |
| 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 | 1068 W BALTIMORE PIKE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MEDIA |
| Zip Code Of The Provider | 19063 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 5 |
| Number Of Services | 2379 |
| Number Of Medicare Beneficiaries | 311 |
| Total Submitted Charge Amount | 237415 |
| Total Medicare Allowed Amount | 193699.79 |
| Total Medicare Payment Amount | 139628.02 |
| Total Medicare Standardized Payment Amount | 132661.17 |
| 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 | 5 |
| Number Of Medical Services | 2379 |
| Number Of Medicare Beneficiaries With Medical Services | 311 |
| Total Medical Submitted Charge Amount | 237415 |
| Total Medical Medicare Allowed Amount | 193699.79 |
| Total Medical Medicare Payment Amount | 139628.02 |
| Total Medical Medicare Standardized Payment Amount | 132661.17 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 50 |
| Number Of Beneficiaries Age 65 to 74 | 66 |
| Number Of Beneficiaries Age 75 to 84 | 67 |
| Number Of Beneficiaries Age Greater 84 | 128 |
| Number Of Female Beneficiaries | 194 |
| Number Of Male Beneficiaries | 117 |
| Number Of Non Hispanic White Beneficiaries | 273 |
| 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 | 16 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 295 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 75 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 35 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 71 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 49 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 22 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 63 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 30 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 2.3864 |