| National Provider Identifier [NPI]: | 1982625869 |
| Last Name Of The Provider | DIVALENTIN |
| First Name Of The Provider | LOUIS |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1010 CHRISTINE AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | ANNISTON |
| Zip Code Of The Provider | 362075710 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 94 |
| Number Of Services | 6996 |
| Number Of Medicare Beneficiaries | 1250 |
| Total Submitted Charge Amount | 681689.41 |
| Total Medicare Allowed Amount | 548808.78 |
| Total Medicare Payment Amount | 408209.75 |
| Total Medicare Standardized Payment Amount | 368370.04 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 363 |
| Number Of Medicare Beneficiaries With Drug Services | 84 |
| Total Drug Submitted ChargeAmount | 7516 |
| Total Drug Medicare AllowedAmount | 1413.4 |
| Total Drug Medicare PaymentAmount | 1172.82 |
| Total Drug Medicare Standardized Payment Amount | 1172.82 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 86 |
| Number Of Medical Services | 6633 |
| Number Of Medicare Beneficiaries With Medical Services | 1250 |
| Total Medical Submitted Charge Amount | 674173.41 |
| Total Medical Medicare Allowed Amount | 547395.38 |
| Total Medical Medicare Payment Amount | 407036.93 |
| Total Medical Medicare Standardized Payment Amount | 367197.22 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 201 |
| Number Of Beneficiaries Age 65 to 74 | 365 |
| Number Of Beneficiaries Age 75 to 84 | 430 |
| Number Of Beneficiaries Age Greater 84 | 254 |
| Number Of Female Beneficiaries | 751 |
| Number Of Male Beneficiaries | 499 |
| Number Of Non Hispanic White Beneficiaries | 1042 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 894 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 356 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 31 |
| Percent Of With Asthma | 14 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 40 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 62 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 60 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 1.8917 |