| National Provider Identifier [NPI]: | 1740211101 |
| Last Name Of The Provider | GANDOLFI |
| First Name Of The Provider | ROY |
| 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 | 3725 W 4100 SOUTH |
| Street Address 2 Of The Provider | |
| City Of The Provider | WEST VALLEY CITY |
| Zip Code Of The Provider | 84120 |
| State Code Of The Provider | UT |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 110 |
| Number Of Services | 6115.5 |
| Number Of Medicare Beneficiaries | 483 |
| Total Submitted Charge Amount | 472296 |
| Total Medicare Allowed Amount | 233752.32 |
| Total Medicare Payment Amount | 177676.74 |
| Total Medicare Standardized Payment Amount | 186348.05 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 759.5 |
| Number Of Medicare Beneficiaries With Drug Services | 254 |
| Total Drug Submitted ChargeAmount | 19238 |
| Total Drug Medicare AllowedAmount | 14699.19 |
| Total Drug Medicare PaymentAmount | 13332.42 |
| Total Drug Medicare Standardized Payment Amount | 13332.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 100 |
| Number Of Medical Services | 5356 |
| Number Of Medicare Beneficiaries With Medical Services | 483 |
| Total Medical Submitted Charge Amount | 453058 |
| Total Medical Medicare Allowed Amount | 219053.13 |
| Total Medical Medicare Payment Amount | 164344.32 |
| Total Medical Medicare Standardized Payment Amount | 173015.63 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 25 |
| Number Of Beneficiaries Age 65 to 74 | 222 |
| Number Of Beneficiaries Age 75 to 84 | 172 |
| Number Of Beneficiaries Age Greater 84 | 64 |
| Number Of Female Beneficiaries | 260 |
| Number Of Male Beneficiaries | 223 |
| Number Of Non Hispanic White Beneficiaries | 440 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 21 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 472 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 11 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 26 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0607 |