| National Provider Identifier [NPI]: | 1154480887 |
| Last Name Of The Provider | EVANGELISTA |
| First Name Of The Provider | ALLAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.P.M., M.P.H. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3120 HIGHLAND RD |
| Street Address 2 Of The Provider | SPECIALTY ORTHOPAEDICS |
| City Of The Provider | HERMITAGE |
| Zip Code Of The Provider | 161484512 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 594 |
| Number Of Medicare Beneficiaries | 65 |
| Total Submitted Charge Amount | 232865 |
| Total Medicare Allowed Amount | 48309.21 |
| Total Medicare Payment Amount | 36506 |
| Total Medicare Standardized Payment Amount | 35885.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 145 |
| Number Of Medicare Beneficiaries With Drug Services | 18 |
| Total Drug Submitted ChargeAmount | 1330 |
| Total Drug Medicare AllowedAmount | 768.18 |
| Total Drug Medicare PaymentAmount | 602.32 |
| Total Drug Medicare Standardized Payment Amount | 602.32 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 54 |
| Number Of Medical Services | 449 |
| Number Of Medicare Beneficiaries With Medical Services | 65 |
| Total Medical Submitted Charge Amount | 231535 |
| Total Medical Medicare Allowed Amount | 47541.03 |
| Total Medical Medicare Payment Amount | 35903.68 |
| Total Medical Medicare Standardized Payment Amount | 35283.35 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 28 |
| Number Of Beneficiaries Age 65 to 74 | 22 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 43 |
| Number Of Male Beneficiaries | 22 |
| 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 | 44 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 21 |
| 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 | 31 |
| Percent Of With Diabetes | 32 |
| Percent Of With Hyperlipidemia | 54 |
| Percent Of With Hypertension | 52 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 74 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0373 |