| National Provider Identifier [NPI]: | 1578658845 |
| Last Name Of The Provider | FAVRET |
| First Name Of The Provider | GERALD |
| 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 | 3501 GOLF ROAD |
| Street Address 2 Of The Provider | |
| City Of The Provider | EAU CLAIRE |
| Zip Code Of The Provider | 54701 |
| State Code Of The Provider | WI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 71 |
| Number Of Services | 719 |
| Number Of Medicare Beneficiaries | 171 |
| Total Submitted Charge Amount | 83529.3 |
| Total Medicare Allowed Amount | 28237.76 |
| Total Medicare Payment Amount | 20313.48 |
| Total Medicare Standardized Payment Amount | 21251.16 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 48 |
| Number Of Medicare Beneficiaries With Drug Services | 39 |
| Total Drug Submitted ChargeAmount | 1040.28 |
| Total Drug Medicare AllowedAmount | 828.51 |
| Total Drug Medicare PaymentAmount | 799.5 |
| Total Drug Medicare Standardized Payment Amount | 799.5 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 64 |
| Number Of Medical Services | 671 |
| Number Of Medicare Beneficiaries With Medical Services | 171 |
| Total Medical Submitted Charge Amount | 82489.02 |
| Total Medical Medicare Allowed Amount | 27409.25 |
| Total Medical Medicare Payment Amount | 19513.98 |
| Total Medical Medicare Standardized Payment Amount | 20451.66 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 56 |
| Number Of Beneficiaries Age 65 to 74 | 67 |
| Number Of Beneficiaries Age 75 to 84 | 29 |
| Number Of Beneficiaries Age Greater 84 | 19 |
| Number Of Female Beneficiaries | 92 |
| Number Of Male Beneficiaries | 79 |
| Number Of Non Hispanic White Beneficiaries | 160 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| 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 | 109 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 62 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 19 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 46 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9583 |