| National Provider Identifier [NPI]: | 1467612671 |
| Last Name Of The Provider | EID |
| First Name Of The Provider | AMALIE |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4555 EMERSON ST |
| Street Address 2 Of The Provider | STE 300 |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322074966 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Gastroenterology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 35 |
| Number Of Services | 1040 |
| Number Of Medicare Beneficiaries | 534 |
| Total Submitted Charge Amount | 542184 |
| Total Medicare Allowed Amount | 115680.81 |
| Total Medicare Payment Amount | 86909.45 |
| Total Medicare Standardized Payment Amount | 87559.19 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 35 |
| Number Of Medical Services | 1040 |
| Number Of Medicare Beneficiaries With Medical Services | 534 |
| Total Medical Submitted Charge Amount | 542184 |
| Total Medical Medicare Allowed Amount | 115680.81 |
| Total Medical Medicare Payment Amount | 86909.45 |
| Total Medical Medicare Standardized Payment Amount | 87559.19 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 226 |
| Number Of Beneficiaries Age 65 to 74 | 203 |
| Number Of Beneficiaries Age 75 to 84 | 83 |
| Number Of Beneficiaries Age Greater 84 | 22 |
| Number Of Female Beneficiaries | 301 |
| Number Of Male Beneficiaries | 233 |
| Number Of Non Hispanic White Beneficiaries | 211 |
| Number Of Black or African American Beneficiaries | 282 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 172 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 362 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 28 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.3202 |