| National Provider Identifier [NPI]: | 1164615811 |
| Last Name Of The Provider | GAULT |
| First Name Of The Provider | LANCE |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2740 HERNDON AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | CLOVIS |
| Zip Code Of The Provider | 936116813 |
| 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 | 28 |
| Number Of Services | 474 |
| Number Of Medicare Beneficiaries | 150 |
| Total Submitted Charge Amount | 20344 |
| Total Medicare Allowed Amount | 18327.97 |
| Total Medicare Payment Amount | 13513.88 |
| Total Medicare Standardized Payment Amount | 14044.75 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 73 |
| Number Of Medicare Beneficiaries With Drug Services | 50 |
| Total Drug Submitted ChargeAmount | 1350 |
| Total Drug Medicare AllowedAmount | 862.56 |
| Total Drug Medicare PaymentAmount | 836.51 |
| Total Drug Medicare Standardized Payment Amount | 836.51 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 22 |
| Number Of Medical Services | 401 |
| Number Of Medicare Beneficiaries With Medical Services | 150 |
| Total Medical Submitted Charge Amount | 18994 |
| Total Medical Medicare Allowed Amount | 17465.41 |
| Total Medical Medicare Payment Amount | 12677.37 |
| Total Medical Medicare Standardized Payment Amount | 13208.24 |
| Average Age Of Beneficiaries | 66 |
| Number Of Beneficiaries Age Less65 | 59 |
| Number Of Beneficiaries Age 65 to 74 | 54 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 88 |
| Number Of Male Beneficiaries | 62 |
| Number Of Non Hispanic White Beneficiaries | 30 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 106 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 65 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 85 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 26 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 30 |
| 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 | 1.0551 |