| National Provider Identifier [NPI]: | 1154512358 |
| Last Name Of The Provider | PEREZ |
| First Name Of The Provider | GARY |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | PHYSICIAN ASSISTANT |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 550 REDSTONE AVE W |
| Street Address 2 Of The Provider | SUITE 370 |
| City Of The Provider | CRESTVIEW |
| Zip Code Of The Provider | 325366428 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 110 |
| Number Of Medicare Beneficiaries | 38 |
| Total Submitted Charge Amount | 27316.17 |
| Total Medicare Allowed Amount | 5916.78 |
| Total Medicare Payment Amount | 4029.2 |
| Total Medicare Standardized Payment Amount | 4832.64 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 29 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 1107.72 |
| Total Drug Medicare AllowedAmount | 253.72 |
| Total Drug Medicare PaymentAmount | 171.62 |
| Total Drug Medicare Standardized Payment Amount | 171.62 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 19 |
| Number Of Medical Services | 81 |
| Number Of Medicare Beneficiaries With Medical Services | 38 |
| Total Medical Submitted Charge Amount | 26208.45 |
| Total Medical Medicare Allowed Amount | 5663.06 |
| Total Medical Medicare Payment Amount | 3857.58 |
| Total Medical Medicare Standardized Payment Amount | 4661.02 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 17 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 22 |
| Number Of Male Beneficiaries | 16 |
| Number Of Non Hispanic White Beneficiaries | |
| Number Of Black or African American Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 39 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 63 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.141 |