| National Provider Identifier [NPI]: | 1619905189 |
| Last Name Of The Provider | PERSICHINO |
| First Name Of The Provider | JON |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 26520 CACTUS AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | MORENO VALLEY |
| Zip Code Of The Provider | 925553927 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 32 |
| Number Of Services | 521 |
| Number Of Medicare Beneficiaries | 157 |
| Total Submitted Charge Amount | 83159 |
| Total Medicare Allowed Amount | 43059.69 |
| Total Medicare Payment Amount | 32160.77 |
| Total Medicare Standardized Payment Amount | 31416.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 17 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 747 |
| Total Drug Medicare AllowedAmount | 355.05 |
| Total Drug Medicare PaymentAmount | 345.8 |
| Total Drug Medicare Standardized Payment Amount | 345.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 26 |
| Number Of Medical Services | 504 |
| Number Of Medicare Beneficiaries With Medical Services | 157 |
| Total Medical Submitted Charge Amount | 82412 |
| Total Medical Medicare Allowed Amount | 42704.64 |
| Total Medical Medicare Payment Amount | 31814.97 |
| Total Medical Medicare Standardized Payment Amount | 31070.58 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 61 |
| Number Of Beneficiaries Age 65 to 74 | 44 |
| Number Of Beneficiaries Age 75 to 84 | 31 |
| Number Of Beneficiaries Age Greater 84 | 21 |
| Number Of Female Beneficiaries | 69 |
| Number Of Male Beneficiaries | 88 |
| Number Of Non Hispanic White Beneficiaries | 63 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 52 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 48 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 109 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 30 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 47 |
| Percent Of With Chronic Kidney Disease | 56 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 34 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 51 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 32 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 15 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 2.7219 |