| National Provider Identifier [NPI]: | 1205802626 |
| Last Name Of The Provider | PETRUCELLI |
| First Name Of The Provider | OLGA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4500 SAN PABLO RD S |
| Street Address 2 Of The Provider | |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322241865 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 1225 |
| Number Of Medicare Beneficiaries | 476 |
| Total Submitted Charge Amount | 113093.26 |
| Total Medicare Allowed Amount | 95184.16 |
| Total Medicare Payment Amount | 65606.8 |
| Total Medicare Standardized Payment Amount | 71504.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 132 |
| Number Of Medicare Beneficiaries With Drug Services | 105 |
| Total Drug Submitted ChargeAmount | 6924.85 |
| Total Drug Medicare AllowedAmount | 6753.28 |
| Total Drug Medicare PaymentAmount | 6448.71 |
| Total Drug Medicare Standardized Payment Amount | 6448.71 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 1093 |
| Number Of Medicare Beneficiaries With Medical Services | 476 |
| Total Medical Submitted Charge Amount | 106168.41 |
| Total Medical Medicare Allowed Amount | 88430.88 |
| Total Medical Medicare Payment Amount | 59158.09 |
| Total Medical Medicare Standardized Payment Amount | 65055.45 |
| Average Age Of Beneficiaries | 79 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 154 |
| Number Of Beneficiaries Age 75 to 84 | 176 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 298 |
| Number Of Male Beneficiaries | 178 |
| Number Of Non Hispanic White Beneficiaries | 441 |
| Number Of Black or African American Beneficiaries | 14 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.082 |