| National Provider Identifier [NPI]: | 1750413175 |
| Last Name Of The Provider | DIBELLA |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 335 E HOUGHTON AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | WEST BRANCH |
| Zip Code Of The Provider | 486611127 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 19 |
| Number Of Services | 2960 |
| Number Of Medicare Beneficiaries | 355 |
| Total Submitted Charge Amount | 535622.62 |
| Total Medicare Allowed Amount | 185650.2 |
| Total Medicare Payment Amount | 143002.62 |
| Total Medicare Standardized Payment Amount | 147199.71 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 1368 |
| Number Of Medicare Beneficiaries With Drug Services | 341 |
| Total Drug Submitted ChargeAmount | 31396.76 |
| Total Drug Medicare AllowedAmount | 5301.31 |
| Total Drug Medicare PaymentAmount | 4113.82 |
| Total Drug Medicare Standardized Payment Amount | 4113.82 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 1592 |
| Number Of Medicare Beneficiaries With Medical Services | 355 |
| Total Medical Submitted Charge Amount | 504225.86 |
| Total Medical Medicare Allowed Amount | 180348.89 |
| Total Medical Medicare Payment Amount | 138888.8 |
| Total Medical Medicare Standardized Payment Amount | 143085.89 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 97 |
| Number Of Beneficiaries Age 65 to 74 | 123 |
| Number Of Beneficiaries Age 75 to 84 | 99 |
| Number Of Beneficiaries Age Greater 84 | 36 |
| Number Of Female Beneficiaries | 198 |
| Number Of Male Beneficiaries | 157 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | 257 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 98 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 28 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 47 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 69 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.1396 |