| National Provider Identifier [NPI]: | 1447364245 |
| Last Name Of The Provider | MENOLASCINO |
| 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 | 5245 HHR RANCH RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | WILSON |
| Zip Code Of The Provider | 830149210 |
| State Code Of The Provider | WY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 77 |
| Number Of Services | 3210 |
| Number Of Medicare Beneficiaries | 772 |
| Total Submitted Charge Amount | 408118.2 |
| Total Medicare Allowed Amount | 185137.31 |
| Total Medicare Payment Amount | 141301.88 |
| Total Medicare Standardized Payment Amount | 141597.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 282 |
| Number Of Medicare Beneficiaries With Drug Services | 134 |
| Total Drug Submitted ChargeAmount | 9634.2 |
| Total Drug Medicare AllowedAmount | 7938.67 |
| Total Drug Medicare PaymentAmount | 7443.49 |
| Total Drug Medicare Standardized Payment Amount | 7443.49 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 67 |
| Number Of Medical Services | 2928 |
| Number Of Medicare Beneficiaries With Medical Services | 772 |
| Total Medical Submitted Charge Amount | 398484 |
| Total Medical Medicare Allowed Amount | 177198.64 |
| Total Medical Medicare Payment Amount | 133858.39 |
| Total Medical Medicare Standardized Payment Amount | 134153.73 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 33 |
| Number Of Beneficiaries Age 65 to 74 | 389 |
| Number Of Beneficiaries Age 75 to 84 | 247 |
| Number Of Beneficiaries Age Greater 84 | 103 |
| Number Of Female Beneficiaries | 345 |
| Number Of Male Beneficiaries | 427 |
| Number Of Non Hispanic White Beneficiaries | 741 |
| 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 | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 725 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 47 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 17 |
| Percent Of With Hyperlipidemia | 38 |
| Percent Of With Hypertension | 54 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 0.9157 |