| National Provider Identifier [NPI]: | 1376848077 |
| Last Name Of The Provider | GREEN |
| First Name Of The Provider | GACHAVIS |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | D.P.M. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 34 FRANKLIN RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | HATTIESBURG |
| Zip Code Of The Provider | 394021318 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 3458 |
| Number Of Medicare Beneficiaries | 759 |
| Total Submitted Charge Amount | 329904 |
| Total Medicare Allowed Amount | 185743.03 |
| Total Medicare Payment Amount | 144976.37 |
| Total Medicare Standardized Payment Amount | 162295.27 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 340 |
| Number Of Medicare Beneficiaries With Drug Services | 145 |
| Total Drug Submitted ChargeAmount | 6800 |
| Total Drug Medicare AllowedAmount | 1824.94 |
| Total Drug Medicare PaymentAmount | 1429.7 |
| Total Drug Medicare Standardized Payment Amount | 1429.7 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 33 |
| Number Of Medical Services | 3118 |
| Number Of Medicare Beneficiaries With Medical Services | 759 |
| Total Medical Submitted Charge Amount | 323104 |
| Total Medical Medicare Allowed Amount | 183918.09 |
| Total Medical Medicare Payment Amount | 143546.67 |
| Total Medical Medicare Standardized Payment Amount | 160865.57 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 155 |
| Number Of Beneficiaries Age 65 to 74 | 224 |
| Number Of Beneficiaries Age 75 to 84 | 229 |
| Number Of Beneficiaries Age Greater 84 | 151 |
| Number Of Female Beneficiaries | 483 |
| Number Of Male Beneficiaries | 276 |
| Number Of Non Hispanic White Beneficiaries | 476 |
| 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 | 376 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 383 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 29 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 31 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.5799 |