| National Provider Identifier [NPI]: | 1245297837 |
| Last Name Of The Provider | FALLICK |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2401 E EVESHAM RD |
| Street Address 2 Of The Provider | SUITE F |
| City Of The Provider | VOORHEES |
| Zip Code Of The Provider | 080439590 |
| State Code Of The Provider | NJ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 79 |
| Number Of Services | 4421 |
| Number Of Medicare Beneficiaries | 717 |
| Total Submitted Charge Amount | 477117.9 |
| Total Medicare Allowed Amount | 256422.07 |
| Total Medicare Payment Amount | 187064.65 |
| Total Medicare Standardized Payment Amount | 180283.87 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 846 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 77414.72 |
| Total Drug Medicare AllowedAmount | 24980.8 |
| Total Drug Medicare PaymentAmount | 19583.07 |
| Total Drug Medicare Standardized Payment Amount | 19583.07 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 71 |
| Number Of Medical Services | 3575 |
| Number Of Medicare Beneficiaries With Medical Services | 717 |
| Total Medical Submitted Charge Amount | 399703.18 |
| Total Medical Medicare Allowed Amount | 231441.27 |
| Total Medical Medicare Payment Amount | 167481.58 |
| Total Medical Medicare Standardized Payment Amount | 160700.8 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 65 |
| Number Of Beneficiaries Age 65 to 74 | 273 |
| Number Of Beneficiaries Age 75 to 84 | 241 |
| Number Of Beneficiaries Age Greater 84 | 138 |
| Number Of Female Beneficiaries | 146 |
| Number Of Male Beneficiaries | 571 |
| Number Of Non Hispanic White Beneficiaries | 613 |
| Number Of Black or African American Beneficiaries | 58 |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 18 |
| Number Of Beneficiaries With Medicare Only Entitlement | 635 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 82 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.6407 |