| National Provider Identifier [NPI]: | 1063488534 |
| Last Name Of The Provider | DEPRET-GUILLAUME |
| First Name Of The Provider | SERGE |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6 HICKOK ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | CHRISTIANSBURG |
| Zip Code Of The Provider | 240733524 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 76 |
| Number Of Services | 1266 |
| Number Of Medicare Beneficiaries | 567 |
| Total Submitted Charge Amount | 167799.1 |
| Total Medicare Allowed Amount | 87365.53 |
| Total Medicare Payment Amount | 56504.67 |
| Total Medicare Standardized Payment Amount | 58264.03 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 109 |
| Number Of Medicare Beneficiaries With Drug Services | 55 |
| Total Drug Submitted ChargeAmount | 3975.1 |
| Total Drug Medicare AllowedAmount | 560.9 |
| Total Drug Medicare PaymentAmount | 382.59 |
| Total Drug Medicare Standardized Payment Amount | 382.59 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 62 |
| Number Of Medical Services | 1157 |
| Number Of Medicare Beneficiaries With Medical Services | 567 |
| Total Medical Submitted Charge Amount | 163824 |
| Total Medical Medicare Allowed Amount | 86804.63 |
| Total Medical Medicare Payment Amount | 56122.08 |
| Total Medical Medicare Standardized Payment Amount | 57881.44 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 78 |
| Number Of Beneficiaries Age 65 to 74 | 250 |
| Number Of Beneficiaries Age 75 to 84 | 174 |
| Number Of Beneficiaries Age Greater 84 | 65 |
| Number Of Female Beneficiaries | 370 |
| Number Of Male Beneficiaries | 197 |
| Number Of Non Hispanic White Beneficiaries | 517 |
| Number Of Black or African American Beneficiaries | 38 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 517 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 50 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 8 |
| 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 | 11 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 61 |
| Percent Of With Ischemic Heart Disease | 25 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9078 |