| National Provider Identifier [NPI]: | 1164428447 |
| Last Name Of The Provider | CRISMOND |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | D |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 13500 SUTTON PARK DRIVE SOUTH |
| Street Address 2 Of The Provider | SUITE 403 |
| City Of The Provider | JACKSONVILLE |
| Zip Code Of The Provider | 322245291 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 17 |
| Number Of Services | 3736 |
| Number Of Medicare Beneficiaries | 1015 |
| Total Submitted Charge Amount | 913007 |
| Total Medicare Allowed Amount | 462551.88 |
| Total Medicare Payment Amount | 361531.69 |
| Total Medicare Standardized Payment Amount | 360001.85 |
| 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 | 17 |
| Number Of Medical Services | 3736 |
| Number Of Medicare Beneficiaries With Medical Services | 1015 |
| Total Medical Submitted Charge Amount | 913007 |
| Total Medical Medicare Allowed Amount | 462551.88 |
| Total Medical Medicare Payment Amount | 361531.69 |
| Total Medical Medicare Standardized Payment Amount | 360001.85 |
| Average Age Of Beneficiaries | 76 |
| Number Of Beneficiaries Age Less65 | 113 |
| Number Of Beneficiaries Age 65 to 74 | 326 |
| Number Of Beneficiaries Age 75 to 84 | 319 |
| Number Of Beneficiaries Age Greater 84 | 257 |
| Number Of Female Beneficiaries | 606 |
| Number Of Male Beneficiaries | 409 |
| Number Of Non Hispanic White Beneficiaries | 885 |
| Number Of Black or African American Beneficiaries | 72 |
| Number Of AsianPacific Islander Beneficiaries | 15 |
| Number Of Hispanic Beneficiaries | 29 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 840 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 175 |
| Percent Of With Atrial Fibrillation | 31 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 48 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 41 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 43 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 65 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 61 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 1.9696 |