| National Provider Identifier [NPI]: | 1053315861 |
| Last Name Of The Provider | GRAVLIN |
| First Name Of The Provider | DEAN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 200 E PENNSYLVANIA AVE |
| Street Address 2 Of The Provider | STE 105 |
| City Of The Provider | PEORIA |
| Zip Code Of The Provider | 616033045 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Geriatric Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 38 |
| Number Of Services | 6339 |
| Number Of Medicare Beneficiaries | 1163 |
| Total Submitted Charge Amount | 548171 |
| Total Medicare Allowed Amount | 275924.42 |
| Total Medicare Payment Amount | 186068.15 |
| Total Medicare Standardized Payment Amount | 195590.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 563 |
| Number Of Medicare Beneficiaries With Drug Services | 408 |
| Total Drug Submitted ChargeAmount | 19934 |
| Total Drug Medicare AllowedAmount | 16323.65 |
| Total Drug Medicare PaymentAmount | 15910.36 |
| Total Drug Medicare Standardized Payment Amount | 15910.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 5776 |
| Number Of Medicare Beneficiaries With Medical Services | 1162 |
| Total Medical Submitted Charge Amount | 528237 |
| Total Medical Medicare Allowed Amount | 259600.77 |
| Total Medical Medicare Payment Amount | 170157.79 |
| Total Medical Medicare Standardized Payment Amount | 179679.7 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 550 |
| Number Of Beneficiaries Age 75 to 84 | 392 |
| Number Of Beneficiaries Age Greater 84 | 183 |
| Number Of Female Beneficiaries | 608 |
| Number Of Male Beneficiaries | 555 |
| Number Of Non Hispanic White Beneficiaries | 1094 |
| Number Of Black or African American Beneficiaries | 43 |
| 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 | 1124 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 39 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 10 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9509 |