| National Provider Identifier [NPI]: | 1386870673 |
| Last Name Of The Provider | GENERILLO |
| First Name Of The Provider | MARLYN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4 PROFESSIONAL PARK DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | WEBSTER |
| Zip Code Of The Provider | 775984127 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 74 |
| Number Of Services | 594 |
| Number Of Medicare Beneficiaries | 160 |
| Total Submitted Charge Amount | 93115 |
| Total Medicare Allowed Amount | 37500.06 |
| Total Medicare Payment Amount | 26544.47 |
| Total Medicare Standardized Payment Amount | 28520.06 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 44 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 5544 |
| Total Drug Medicare AllowedAmount | 1048.92 |
| Total Drug Medicare PaymentAmount | 900.43 |
| Total Drug Medicare Standardized Payment Amount | 900.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 64 |
| Number Of Medical Services | 550 |
| Number Of Medicare Beneficiaries With Medical Services | 160 |
| Total Medical Submitted Charge Amount | 87571 |
| Total Medical Medicare Allowed Amount | 36451.14 |
| Total Medical Medicare Payment Amount | 25644.04 |
| Total Medical Medicare Standardized Payment Amount | 27619.63 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 40 |
| Number Of Beneficiaries Age 65 to 74 | 69 |
| Number Of Beneficiaries Age 75 to 84 | 37 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 115 |
| Number Of Male Beneficiaries | 45 |
| Number Of Non Hispanic White Beneficiaries | 135 |
| Number Of Black or African American Beneficiaries | |
| 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 | 119 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 41 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 23 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.2867 |