| National Provider Identifier [NPI]: | 1023024973 |
| Last Name Of The Provider | PENILLA |
| First Name Of The Provider | GREGORIUS |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 14309 MANCHESTER RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | MANCHESTER |
| Zip Code Of The Provider | 630114050 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 36 |
| Number Of Services | 1207 |
| Number Of Medicare Beneficiaries | 242 |
| Total Submitted Charge Amount | 90501 |
| Total Medicare Allowed Amount | 60498.49 |
| Total Medicare Payment Amount | 43406.61 |
| Total Medicare Standardized Payment Amount | 44695.32 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 135 |
| Number Of Medicare Beneficiaries With Drug Services | 121 |
| Total Drug Submitted ChargeAmount | 6296 |
| Total Drug Medicare AllowedAmount | 3966.39 |
| Total Drug Medicare PaymentAmount | 3842.99 |
| Total Drug Medicare Standardized Payment Amount | 3842.99 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 1072 |
| Number Of Medicare Beneficiaries With Medical Services | 242 |
| Total Medical Submitted Charge Amount | 84205 |
| Total Medical Medicare Allowed Amount | 56532.1 |
| Total Medical Medicare Payment Amount | 39563.62 |
| Total Medical Medicare Standardized Payment Amount | 40852.33 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 127 |
| Number Of Beneficiaries Age 75 to 84 | 76 |
| Number Of Beneficiaries Age Greater 84 | 24 |
| Number Of Female Beneficiaries | 132 |
| Number Of Male Beneficiaries | 110 |
| Number Of Non Hispanic White Beneficiaries | 218 |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 9 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.7478 |