| National Provider Identifier [NPI]: | 1972808129 |
| Last Name Of The Provider | GALLO |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MSN, ARNP, FNP-BC |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4684 HIGHWAY 90 |
| Street Address 2 Of The Provider | |
| City Of The Provider | MARIANNA |
| Zip Code Of The Provider | 324463503 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 264 |
| Number Of Medicare Beneficiaries | 151 |
| Total Submitted Charge Amount | 10401.13 |
| Total Medicare Allowed Amount | 9622.25 |
| Total Medicare Payment Amount | 7223.99 |
| Total Medicare Standardized Payment Amount | 8356.12 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 93 |
| Number Of Medicare Beneficiaries With Drug Services | 90 |
| Total Drug Submitted ChargeAmount | 2299.13 |
| Total Drug Medicare AllowedAmount | 2299.13 |
| Total Drug Medicare PaymentAmount | 2251.15 |
| Total Drug Medicare Standardized Payment Amount | 2251.15 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 13 |
| Number Of Medical Services | 171 |
| Number Of Medicare Beneficiaries With Medical Services | 151 |
| Total Medical Submitted Charge Amount | 8102 |
| Total Medical Medicare Allowed Amount | 7323.12 |
| Total Medical Medicare Payment Amount | 4972.84 |
| Total Medical Medicare Standardized Payment Amount | 6104.97 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 84 |
| Number Of Beneficiaries Age 75 to 84 | 45 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 98 |
| Number Of Male Beneficiaries | 53 |
| Number Of Non Hispanic White Beneficiaries | 133 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 137 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 14 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 56 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7641 |