| National Provider Identifier [NPI]: | 1336159607 |
| Last Name Of The Provider | GALLARDO |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 104 ASBURY CIR |
| Street Address 2 Of The Provider | |
| City Of The Provider | HATTIESBURG |
| Zip Code Of The Provider | 394021302 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 92 |
| Number Of Services | 11972 |
| Number Of Medicare Beneficiaries | 1569 |
| Total Submitted Charge Amount | 1396665 |
| Total Medicare Allowed Amount | 543815.37 |
| Total Medicare Payment Amount | 382063.2 |
| Total Medicare Standardized Payment Amount | 420887.9 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 119 |
| Number Of Medicare Beneficiaries With Drug Services | 57 |
| Total Drug Submitted ChargeAmount | 21832 |
| Total Drug Medicare AllowedAmount | 12408.66 |
| Total Drug Medicare PaymentAmount | 9310.63 |
| Total Drug Medicare Standardized Payment Amount | 9310.63 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 89 |
| Number Of Medical Services | 11853 |
| Number Of Medicare Beneficiaries With Medical Services | 1569 |
| Total Medical Submitted Charge Amount | 1374833 |
| Total Medical Medicare Allowed Amount | 531406.71 |
| Total Medical Medicare Payment Amount | 372752.57 |
| Total Medical Medicare Standardized Payment Amount | 411577.27 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 160 |
| Number Of Beneficiaries Age 65 to 74 | 828 |
| Number Of Beneficiaries Age 75 to 84 | 469 |
| Number Of Beneficiaries Age Greater 84 | 112 |
| Number Of Female Beneficiaries | 800 |
| Number Of Male Beneficiaries | 769 |
| Number Of Non Hispanic White Beneficiaries | 1484 |
| Number Of Black or African American Beneficiaries | 67 |
| 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 | 1395 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 174 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.9204 |