| National Provider Identifier [NPI]: | 1144287434 |
| Last Name Of The Provider | EVANGELISTA |
| First Name Of The Provider | EDMUND |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 26401 CROWN VALLEY PKWY |
| Street Address 2 Of The Provider | SUITE 101 |
| City Of The Provider | MISSION VIEJO |
| Zip Code Of The Provider | 926916302 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physical Medicine and Rehabilitation |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 83 |
| Number Of Services | 2230 |
| Number Of Medicare Beneficiaries | 394 |
| Total Submitted Charge Amount | 744151.48 |
| Total Medicare Allowed Amount | 244649.49 |
| Total Medicare Payment Amount | 186720.19 |
| Total Medicare Standardized Payment Amount | 163460.39 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 191 |
| Number Of Medicare Beneficiaries With Drug Services | 55 |
| Total Drug Submitted ChargeAmount | 15285 |
| Total Drug Medicare AllowedAmount | 7512.64 |
| Total Drug Medicare PaymentAmount | 5889.92 |
| Total Drug Medicare Standardized Payment Amount | 5889.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 80 |
| Number Of Medical Services | 2039 |
| Number Of Medicare Beneficiaries With Medical Services | 394 |
| Total Medical Submitted Charge Amount | 728866.48 |
| Total Medical Medicare Allowed Amount | 237136.85 |
| Total Medical Medicare Payment Amount | 180830.27 |
| Total Medical Medicare Standardized Payment Amount | 157570.47 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 19 |
| Number Of Beneficiaries Age 65 to 74 | 187 |
| Number Of Beneficiaries Age 75 to 84 | 131 |
| Number Of Beneficiaries Age Greater 84 | 57 |
| Number Of Female Beneficiaries | 261 |
| Number Of Male Beneficiaries | 133 |
| Number Of Non Hispanic White Beneficiaries | 370 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 377 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0791 |