| National Provider Identifier [NPI]: | 1760485098 |
| Last Name Of The Provider | FAVAZZA |
| First Name Of The Provider | TERENCE |
| 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 | 2260 W ORANGE GROVE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | TUCSON |
| Zip Code Of The Provider | 857413117 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 87 |
| Number Of Services | 6058 |
| Number Of Medicare Beneficiaries | 594 |
| Total Submitted Charge Amount | 489960.51 |
| Total Medicare Allowed Amount | 217731.31 |
| Total Medicare Payment Amount | 160975.03 |
| Total Medicare Standardized Payment Amount | 162495.86 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 14 |
| Number Of Drug Services | 3229 |
| Number Of Medicare Beneficiaries With Drug Services | 87 |
| Total Drug Submitted ChargeAmount | 117731 |
| Total Drug Medicare AllowedAmount | 37742.62 |
| Total Drug Medicare PaymentAmount | 29397.1 |
| Total Drug Medicare Standardized Payment Amount | 29397.1 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 73 |
| Number Of Medical Services | 2829 |
| Number Of Medicare Beneficiaries With Medical Services | 594 |
| Total Medical Submitted Charge Amount | 372229.51 |
| Total Medical Medicare Allowed Amount | 179988.69 |
| Total Medical Medicare Payment Amount | 131577.93 |
| Total Medical Medicare Standardized Payment Amount | 133098.76 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 26 |
| Number Of Beneficiaries Age 65 to 74 | 256 |
| Number Of Beneficiaries Age 75 to 84 | 212 |
| Number Of Beneficiaries Age Greater 84 | 100 |
| Number Of Female Beneficiaries | 154 |
| Number Of Male Beneficiaries | 440 |
| Number Of Non Hispanic White Beneficiaries | 512 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 56 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 13 |
| Number Of Beneficiaries With Medicare Only Entitlement | 552 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 42 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 65 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0507 |