| National Provider Identifier [NPI]: | 1215078399 |
| Last Name Of The Provider | KRYSTAL |
| First Name Of The Provider | ALAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1582 W SAN MARCOS BLVD STE 100 |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAN MARCOS |
| Zip Code Of The Provider | 920784081 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 25 |
| Number Of Services | 644 |
| Number Of Medicare Beneficiaries | 169 |
| Total Submitted Charge Amount | 101439 |
| Total Medicare Allowed Amount | 91899.3 |
| Total Medicare Payment Amount | 67415.8 |
| Total Medicare Standardized Payment Amount | 65494.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 18 |
| Number Of Medicare Beneficiaries With Drug Services | 14 |
| Total Drug Submitted ChargeAmount | 150 |
| Total Drug Medicare AllowedAmount | 74.67 |
| Total Drug Medicare PaymentAmount | 67.38 |
| Total Drug Medicare Standardized Payment Amount | 67.38 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 22 |
| Number Of Medical Services | 626 |
| Number Of Medicare Beneficiaries With Medical Services | 169 |
| Total Medical Submitted Charge Amount | 101289 |
| Total Medical Medicare Allowed Amount | 91824.63 |
| Total Medical Medicare Payment Amount | 67348.42 |
| Total Medical Medicare Standardized Payment Amount | 65427.07 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 67 |
| Number Of Beneficiaries Age 65 to 74 | 26 |
| Number Of Beneficiaries Age 75 to 84 | 31 |
| Number Of Beneficiaries Age Greater 84 | 45 |
| Number Of Female Beneficiaries | 96 |
| Number Of Male Beneficiaries | 73 |
| Number Of Non Hispanic White Beneficiaries | 138 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 14 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 59 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 110 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 50 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 30 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 37 |
| Percent Of With Depression | 56 |
| Percent Of With Diabetes | 57 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 51 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.3495 |