| National Provider Identifier [NPI]: | 1932174794 |
| Last Name Of The Provider | FALLON |
| First Name Of The Provider | DIEGO |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 117 W BAY ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | WAUCHULA |
| Zip Code Of The Provider | 338733135 |
| 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 | 61 |
| Number Of Services | 3731 |
| Number Of Medicare Beneficiaries | 627 |
| Total Submitted Charge Amount | 372507.29 |
| Total Medicare Allowed Amount | 370200.66 |
| Total Medicare Payment Amount | 267531.11 |
| Total Medicare Standardized Payment Amount | 274002.31 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 352 |
| Number Of Medicare Beneficiaries With Drug Services | 271 |
| Total Drug Submitted ChargeAmount | 6479.93 |
| Total Drug Medicare AllowedAmount | 6479.15 |
| Total Drug Medicare PaymentAmount | 6304.22 |
| Total Drug Medicare Standardized Payment Amount | 6304.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 55 |
| Number Of Medical Services | 3379 |
| Number Of Medicare Beneficiaries With Medical Services | 627 |
| Total Medical Submitted Charge Amount | 366027.36 |
| Total Medical Medicare Allowed Amount | 363721.51 |
| Total Medical Medicare Payment Amount | 261226.89 |
| Total Medical Medicare Standardized Payment Amount | 267698.09 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 96 |
| Number Of Beneficiaries Age 65 to 74 | 240 |
| Number Of Beneficiaries Age 75 to 84 | 202 |
| Number Of Beneficiaries Age Greater 84 | 89 |
| Number Of Female Beneficiaries | 353 |
| Number Of Male Beneficiaries | 274 |
| Number Of Non Hispanic White Beneficiaries | 514 |
| Number Of Black or African American Beneficiaries | 29 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 73 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 474 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 153 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 29 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 17 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2974 |