| National Provider Identifier [NPI]: | 1780641506 |
| Last Name Of The Provider | MELLICK |
| First Name Of The Provider | GARY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 309 MEDICAL CENTER DR SW |
| Street Address 2 Of The Provider | |
| City Of The Provider | FORT PAYNE |
| Zip Code Of The Provider | 359683420 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Neurology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 40 |
| Number Of Services | 2476 |
| Number Of Medicare Beneficiaries | 717 |
| Total Submitted Charge Amount | 565030.15 |
| Total Medicare Allowed Amount | 219039.53 |
| Total Medicare Payment Amount | 161092.63 |
| Total Medicare Standardized Payment Amount | 176960.84 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 340 |
| Number Of Medicare Beneficiaries With Drug Services | 149 |
| Total Drug Submitted ChargeAmount | 3397.6 |
| Total Drug Medicare AllowedAmount | 600.98 |
| Total Drug Medicare PaymentAmount | 424.05 |
| Total Drug Medicare Standardized Payment Amount | 424.05 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 38 |
| Number Of Medical Services | 2136 |
| Number Of Medicare Beneficiaries With Medical Services | 716 |
| Total Medical Submitted Charge Amount | 561632.55 |
| Total Medical Medicare Allowed Amount | 218438.55 |
| Total Medical Medicare Payment Amount | 160668.58 |
| Total Medical Medicare Standardized Payment Amount | 176536.79 |
| Average Age Of Beneficiaries | 65 |
| Number Of Beneficiaries Age Less65 | 278 |
| Number Of Beneficiaries Age 65 to 74 | 233 |
| Number Of Beneficiaries Age 75 to 84 | 156 |
| Number Of Beneficiaries Age Greater 84 | 50 |
| Number Of Female Beneficiaries | 423 |
| Number Of Male Beneficiaries | 294 |
| Number Of Non Hispanic White Beneficiaries | 670 |
| Number Of Black or African American Beneficiaries | 33 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 437 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 280 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 22 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 36 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 15 |
| Average HCC Risk Score Of Beneficiaries | 1.3827 |