| National Provider Identifier [NPI]: | 1366470403 |
| Last Name Of The Provider | COSTELLO |
| First Name Of The Provider | MICHAEL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2215 NEBRASKA AVE |
| Street Address 2 Of The Provider | SUITE 3D |
| City Of The Provider | FORT PIERCE |
| Zip Code Of The Provider | 349504864 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 201 |
| Number Of Services | 3636 |
| Number Of Medicare Beneficiaries | 1035 |
| Total Submitted Charge Amount | 941616.69 |
| Total Medicare Allowed Amount | 523042.72 |
| Total Medicare Payment Amount | 402181.75 |
| Total Medicare Standardized Payment Amount | 375811.33 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 201 |
| Number Of Medical Services | 3636 |
| Number Of Medicare Beneficiaries With Medical Services | 1035 |
| Total Medical Submitted Charge Amount | 941616.69 |
| Total Medical Medicare Allowed Amount | 523042.72 |
| Total Medical Medicare Payment Amount | 402181.75 |
| Total Medical Medicare Standardized Payment Amount | 375811.33 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 167 |
| Number Of Beneficiaries Age 65 to 74 | 318 |
| Number Of Beneficiaries Age 75 to 84 | 357 |
| Number Of Beneficiaries Age Greater 84 | 193 |
| Number Of Female Beneficiaries | 496 |
| Number Of Male Beneficiaries | 539 |
| Number Of Non Hispanic White Beneficiaries | 779 |
| Number Of Black or African American Beneficiaries | 183 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 53 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 742 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 293 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 46 |
| Percent Of With Chronic Kidney Disease | 51 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 36 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 75 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 33 |
| Average HCC Risk Score Of Beneficiaries | 2.585 |