| National Provider Identifier [NPI]: | 1821157033 |
| Last Name Of The Provider | GRIMALDI |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 450 4TH AVE |
| Street Address 2 Of The Provider | SUITE 312 |
| City Of The Provider | CHULA VISTA |
| Zip Code Of The Provider | 919104426 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 85 |
| Number Of Services | 5139 |
| Number Of Medicare Beneficiaries | 1027 |
| Total Submitted Charge Amount | 1876891.76 |
| Total Medicare Allowed Amount | 745220.52 |
| Total Medicare Payment Amount | 561367.47 |
| Total Medicare Standardized Payment Amount | 539666.69 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 455 |
| Number Of Medicare Beneficiaries With Drug Services | 57 |
| Total Drug Submitted ChargeAmount | 237785 |
| Total Drug Medicare AllowedAmount | 94229.75 |
| Total Drug Medicare PaymentAmount | 72112.25 |
| Total Drug Medicare Standardized Payment Amount | 72112.25 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 80 |
| Number Of Medical Services | 4684 |
| Number Of Medicare Beneficiaries With Medical Services | 1027 |
| Total Medical Submitted Charge Amount | 1639106.76 |
| Total Medical Medicare Allowed Amount | 650990.77 |
| Total Medical Medicare Payment Amount | 489255.22 |
| Total Medical Medicare Standardized Payment Amount | 467554.44 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 113 |
| Number Of Beneficiaries Age 65 to 74 | 342 |
| Number Of Beneficiaries Age 75 to 84 | 384 |
| Number Of Beneficiaries Age Greater 84 | 188 |
| Number Of Female Beneficiaries | 216 |
| Number Of Male Beneficiaries | 811 |
| Number Of Non Hispanic White Beneficiaries | 268 |
| Number Of Black or African American Beneficiaries | 37 |
| Number Of AsianPacific Islander Beneficiaries | 86 |
| Number Of Hispanic Beneficiaries | 603 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 421 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 606 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 18 |
| Percent Of With Heart Failure | 33 |
| Percent Of With Chronic Kidney Disease | 41 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 21 |
| Percent Of With Diabetes | 54 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 44 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.7747 |