| National Provider Identifier [NPI]: | 1275538365 |
| Last Name Of The Provider | SALLY |
| First Name Of The Provider | ALAN |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 631A NATIONAL PIKE E |
| Street Address 2 Of The Provider | |
| City Of The Provider | BROWNSVILLE |
| Zip Code Of The Provider | 154179603 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 56 |
| Number Of Services | 1699 |
| Number Of Medicare Beneficiaries | 323 |
| Total Submitted Charge Amount | 132415.19 |
| Total Medicare Allowed Amount | 83576.8 |
| Total Medicare Payment Amount | 59645.43 |
| Total Medicare Standardized Payment Amount | 63115.29 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 205 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 13005.86 |
| Total Drug Medicare AllowedAmount | 7371.75 |
| Total Drug Medicare PaymentAmount | 5776.2 |
| Total Drug Medicare Standardized Payment Amount | 5776.2 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 53 |
| Number Of Medical Services | 1494 |
| Number Of Medicare Beneficiaries With Medical Services | 323 |
| Total Medical Submitted Charge Amount | 119409.33 |
| Total Medical Medicare Allowed Amount | 76205.05 |
| Total Medical Medicare Payment Amount | 53869.23 |
| Total Medical Medicare Standardized Payment Amount | 57339.09 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 86 |
| Number Of Beneficiaries Age 75 to 84 | 89 |
| Number Of Beneficiaries Age Greater 84 | 110 |
| Number Of Female Beneficiaries | 180 |
| Number Of Male Beneficiaries | 143 |
| Number Of Non Hispanic White Beneficiaries | 300 |
| 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 | 265 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 58 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.4165 |