| National Provider Identifier [NPI]: | 1538148929 |
| Last Name Of The Provider | CARRILLO |
| First Name Of The Provider | MARISSA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | PA |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1125 E SPRUCE AVE STE 207 |
| Street Address 2 Of The Provider | |
| City Of The Provider | FRESNO |
| Zip Code Of The Provider | 937203390 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 68 |
| Number Of Services | 3910 |
| Number Of Medicare Beneficiaries | 863 |
| Total Submitted Charge Amount | 318124 |
| Total Medicare Allowed Amount | 192590.83 |
| Total Medicare Payment Amount | 138962.42 |
| Total Medicare Standardized Payment Amount | 159033.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 48 |
| Number Of Medicare Beneficiaries With Drug Services | 33 |
| Total Drug Submitted ChargeAmount | 5073 |
| Total Drug Medicare AllowedAmount | 4181.31 |
| Total Drug Medicare PaymentAmount | 3136.21 |
| Total Drug Medicare Standardized Payment Amount | 3136.21 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 64 |
| Number Of Medical Services | 3862 |
| Number Of Medicare Beneficiaries With Medical Services | 862 |
| Total Medical Submitted Charge Amount | 313051 |
| Total Medical Medicare Allowed Amount | 188409.52 |
| Total Medical Medicare Payment Amount | 135826.21 |
| Total Medical Medicare Standardized Payment Amount | 155897.19 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 23 |
| Number Of Beneficiaries Age 65 to 74 | 501 |
| Number Of Beneficiaries Age 75 to 84 | 247 |
| Number Of Beneficiaries Age Greater 84 | 92 |
| Number Of Female Beneficiaries | 562 |
| Number Of Male Beneficiaries | 301 |
| Number Of Non Hispanic White Beneficiaries | 793 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 34 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 17 |
| Number Of Beneficiaries With Medicare Only Entitlement | 849 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 14 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.8226 |