| National Provider Identifier [NPI]: | 1477866150 |
| Last Name Of The Provider | D'MELLO |
| First Name Of The Provider | KEVIN |
| Middle Initial Of The Provider | F |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2501 MEREDITH ST |
| Street Address 2 Of The Provider | FLOOR 2 |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191302421 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 11 |
| Number Of Services | 310 |
| Number Of Medicare Beneficiaries | 230 |
| Total Submitted Charge Amount | 83888 |
| Total Medicare Allowed Amount | 51894.23 |
| Total Medicare Payment Amount | 39027.15 |
| Total Medicare Standardized Payment Amount | 37390.33 |
| 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 | 11 |
| Number Of Medical Services | 310 |
| Number Of Medicare Beneficiaries With Medical Services | 230 |
| Total Medical Submitted Charge Amount | 83888 |
| Total Medical Medicare Allowed Amount | 51894.23 |
| Total Medical Medicare Payment Amount | 39027.15 |
| Total Medical Medicare Standardized Payment Amount | 37390.33 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 93 |
| Number Of Beneficiaries Age 65 to 74 | 68 |
| Number Of Beneficiaries Age 75 to 84 | 33 |
| Number Of Beneficiaries Age Greater 84 | 36 |
| Number Of Female Beneficiaries | 125 |
| Number Of Male Beneficiaries | 105 |
| Number Of Non Hispanic White Beneficiaries | 85 |
| Number Of Black or African American Beneficiaries | 128 |
| 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 | 83 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 147 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 32 |
| Percent Of With Asthma | 25 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 52 |
| Percent Of With Chronic Kidney Disease | 60 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 37 |
| Percent Of With Depression | 45 |
| Percent Of With Diabetes | 55 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 58 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 55 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 20 |
| Percent Of With Stroke | 18 |
| Average HCC Risk Score Of Beneficiaries | 3.1094 |