| National Provider Identifier [NPI]: | 1093727166 |
| Last Name Of The Provider | STARK |
| First Name Of The Provider | EDWARD |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 500 MEDICAL CENTER BLVD |
| Street Address 2 Of The Provider | SUITE 220 |
| City Of The Provider | LAWRENCEVILLE |
| Zip Code Of The Provider | 30046 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 78 |
| Number Of Services | 3305 |
| Number Of Medicare Beneficiaries | 507 |
| Total Submitted Charge Amount | 585606 |
| Total Medicare Allowed Amount | 187357.14 |
| Total Medicare Payment Amount | 140433.74 |
| Total Medicare Standardized Payment Amount | 141109.48 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 1077 |
| Number Of Medicare Beneficiaries With Drug Services | 38 |
| Total Drug Submitted ChargeAmount | 149881 |
| Total Drug Medicare AllowedAmount | 38533.99 |
| Total Drug Medicare PaymentAmount | 29950.43 |
| Total Drug Medicare Standardized Payment Amount | 29950.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 71 |
| Number Of Medical Services | 2228 |
| Number Of Medicare Beneficiaries With Medical Services | 507 |
| Total Medical Submitted Charge Amount | 435725 |
| Total Medical Medicare Allowed Amount | 148823.15 |
| Total Medical Medicare Payment Amount | 110483.31 |
| Total Medical Medicare Standardized Payment Amount | 111159.05 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 55 |
| Number Of Beneficiaries Age 65 to 74 | 236 |
| Number Of Beneficiaries Age 75 to 84 | 164 |
| Number Of Beneficiaries Age Greater 84 | 52 |
| Number Of Female Beneficiaries | 127 |
| Number Of Male Beneficiaries | 380 |
| Number Of Non Hispanic White Beneficiaries | 398 |
| Number Of Black or African American Beneficiaries | 70 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 18 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 442 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 65 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 26 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 34 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.2245 |