| National Provider Identifier [NPI]: | 1558400788 |
| Last Name Of The Provider | PENNELLA |
| First Name Of The Provider | RAFFAELE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1229 E SEMINOLE ST |
| Street Address 2 Of The Provider | SUITE 510 |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 658042227 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 83 |
| Number Of Services | 14596 |
| Number Of Medicare Beneficiaries | 4092 |
| Total Submitted Charge Amount | 1902989 |
| Total Medicare Allowed Amount | 678973.91 |
| Total Medicare Payment Amount | 474774.15 |
| Total Medicare Standardized Payment Amount | 483624.64 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 12 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 552 |
| Total Drug Medicare AllowedAmount | 98.26 |
| Total Drug Medicare PaymentAmount | 57.77 |
| Total Drug Medicare Standardized Payment Amount | 57.77 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 81 |
| Number Of Medical Services | 14584 |
| Number Of Medicare Beneficiaries With Medical Services | 4092 |
| Total Medical Submitted Charge Amount | 1902437 |
| Total Medical Medicare Allowed Amount | 678875.65 |
| Total Medical Medicare Payment Amount | 474716.38 |
| Total Medical Medicare Standardized Payment Amount | 483566.87 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 261 |
| Number Of Beneficiaries Age 65 to 74 | 1753 |
| Number Of Beneficiaries Age 75 to 84 | 1501 |
| Number Of Beneficiaries Age Greater 84 | 577 |
| Number Of Female Beneficiaries | 1805 |
| Number Of Male Beneficiaries | 2287 |
| Number Of Non Hispanic White Beneficiaries | 4032 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 11 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 31 |
| Number Of Beneficiaries With Medicare Only Entitlement | 3833 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 259 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 30 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 1.0051 |