| National Provider Identifier [NPI]: | 1326159021 |
| Last Name Of The Provider | DESNOYERS |
| First Name Of The Provider | RODWIGE |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 925 CHESTUNUT STREET |
| Street Address 2 Of The Provider | SUITE 320A |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 19107 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Maxillofacial Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 5234 |
| Number Of Medicare Beneficiaries | 134 |
| Total Submitted Charge Amount | 277914 |
| Total Medicare Allowed Amount | 112202.57 |
| Total Medicare Payment Amount | 85617.47 |
| Total Medicare Standardized Payment Amount | 86415.55 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 27 |
| Number Of Drug Services | 4769 |
| Number Of Medicare Beneficiaries With Drug Services | 19 |
| Total Drug Submitted ChargeAmount | 187931 |
| Total Drug Medicare AllowedAmount | 70338.51 |
| Total Drug Medicare PaymentAmount | 55065.08 |
| Total Drug Medicare Standardized Payment Amount | 55065.08 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 27 |
| Number Of Medical Services | 465 |
| Number Of Medicare Beneficiaries With Medical Services | 134 |
| Total Medical Submitted Charge Amount | 89983 |
| Total Medical Medicare Allowed Amount | 41864.06 |
| Total Medical Medicare Payment Amount | 30552.39 |
| Total Medical Medicare Standardized Payment Amount | 31350.47 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 23 |
| Number Of Beneficiaries Age 65 to 74 | 56 |
| Number Of Beneficiaries Age 75 to 84 | 40 |
| Number Of Beneficiaries Age Greater 84 | 15 |
| Number Of Female Beneficiaries | 72 |
| Number Of Male Beneficiaries | 62 |
| Number Of Non Hispanic White Beneficiaries | 97 |
| 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 | 105 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 29 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 57 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 26 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 46 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 46 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 2.1502 |