| National Provider Identifier [NPI]: | 1700849411 |
| Last Name Of The Provider | MALLETTE |
| First Name Of The Provider | STEPHEN |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 707 US HIGHWAY 31 S |
| Street Address 2 Of The Provider | SUITE F |
| City Of The Provider | ATHENS |
| Zip Code Of The Provider | 356113619 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 51 |
| Number Of Services | 5188 |
| Number Of Medicare Beneficiaries | 1512 |
| Total Submitted Charge Amount | 490321.99 |
| Total Medicare Allowed Amount | 281001.15 |
| Total Medicare Payment Amount | 194564.9 |
| Total Medicare Standardized Payment Amount | 218534.3 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
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| Number Of Medicare Beneficiaries With Medical Services | |
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| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 79 |
| Number Of Beneficiaries Age 65 to 74 | 694 |
| Number Of Beneficiaries Age 75 to 84 | 548 |
| Number Of Beneficiaries Age Greater 84 | 191 |
| Number Of Female Beneficiaries | 793 |
| Number Of Male Beneficiaries | 719 |
| Number Of Non Hispanic White Beneficiaries | 1468 |
| Number Of Black or African American Beneficiaries | 32 |
| 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 | 1384 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 128 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0081 |