| National Provider Identifier [NPI]: | 1053552471 |
| Last Name Of The Provider | MENA |
| First Name Of The Provider | DERRICK |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6423 DOLPHIN SHORES DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | PANAMA CITY BEACH |
| Zip Code Of The Provider | 324075467 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 15 |
| Number Of Services | 703 |
| Number Of Medicare Beneficiaries | 633 |
| Total Submitted Charge Amount | 286934 |
| Total Medicare Allowed Amount | 135922.85 |
| Total Medicare Payment Amount | 100857.39 |
| Total Medicare Standardized Payment Amount | 100271.67 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 15 |
| Number Of Medical Services | 703 |
| Number Of Medicare Beneficiaries With Medical Services | 633 |
| Total Medical Submitted Charge Amount | 286934 |
| Total Medical Medicare Allowed Amount | 135922.85 |
| Total Medical Medicare Payment Amount | 100857.39 |
| Total Medical Medicare Standardized Payment Amount | 100271.67 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 165 |
| Number Of Beneficiaries Age 65 to 74 | 183 |
| Number Of Beneficiaries Age 75 to 84 | 200 |
| Number Of Beneficiaries Age Greater 84 | 85 |
| Number Of Female Beneficiaries | 356 |
| Number Of Male Beneficiaries | 277 |
| Number Of Non Hispanic White Beneficiaries | 564 |
| Number Of Black or African American Beneficiaries | 42 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 13 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 409 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 224 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 53 |
| Percent Of With Chronic Kidney Disease | 53 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 49 |
| Percent Of With Depression | 44 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 70 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 19 |
| Average HCC Risk Score Of Beneficiaries | 2.1099 |