| National Provider Identifier [NPI]: | 1356311583 |
| Last Name Of The Provider | GALLENTINE |
| First Name Of The Provider | MICHAEL |
| 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 | 611 W FRANCIS ST |
| Street Address 2 Of The Provider | SUITE 230 |
| City Of The Provider | NORTH PLATTE |
| Zip Code Of The Provider | 691010620 |
| State Code Of The Provider | NE |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 112 |
| Number Of Services | 5269 |
| Number Of Medicare Beneficiaries | 940 |
| Total Submitted Charge Amount | 1503811 |
| Total Medicare Allowed Amount | 389589.76 |
| Total Medicare Payment Amount | 291734.7 |
| Total Medicare Standardized Payment Amount | 313176.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 867 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 41881 |
| Total Drug Medicare AllowedAmount | 24939.47 |
| Total Drug Medicare PaymentAmount | 19434.73 |
| Total Drug Medicare Standardized Payment Amount | 19434.73 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 106 |
| Number Of Medical Services | 4402 |
| Number Of Medicare Beneficiaries With Medical Services | 940 |
| Total Medical Submitted Charge Amount | 1461930 |
| Total Medical Medicare Allowed Amount | 364650.29 |
| Total Medical Medicare Payment Amount | 272299.97 |
| Total Medical Medicare Standardized Payment Amount | 293742.13 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 79 |
| Number Of Beneficiaries Age 65 to 74 | 360 |
| Number Of Beneficiaries Age 75 to 84 | 334 |
| Number Of Beneficiaries Age Greater 84 | 167 |
| Number Of Female Beneficiaries | 242 |
| Number Of Male Beneficiaries | 698 |
| Number Of Non Hispanic White Beneficiaries | 906 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 15 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 819 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 121 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 20 |
| Percent Of With Heart Failure | 23 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.3405 |