| National Provider Identifier [NPI]: | 1043228158 |
| Last Name Of The Provider | MASSULLO |
| First Name Of The Provider | MARIO |
| 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 | 1710 W. COURT ST. |
| Street Address 2 Of The Provider | |
| City Of The Provider | KANKAKEE |
| Zip Code Of The Provider | 60901 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiac Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 119 |
| Number Of Services | 8342 |
| Number Of Medicare Beneficiaries | 2101 |
| Total Submitted Charge Amount | 1580008 |
| Total Medicare Allowed Amount | 695907.88 |
| Total Medicare Payment Amount | 520349.8 |
| Total Medicare Standardized Payment Amount | 536226.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 396 |
| Number Of Medicare Beneficiaries With Drug Services | 146 |
| Total Drug Submitted ChargeAmount | 25146 |
| Total Drug Medicare AllowedAmount | 13290.63 |
| Total Drug Medicare PaymentAmount | 10336.37 |
| Total Drug Medicare Standardized Payment Amount | 10336.37 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 117 |
| Number Of Medical Services | 7946 |
| Number Of Medicare Beneficiaries With Medical Services | 2101 |
| Total Medical Submitted Charge Amount | 1554862 |
| Total Medical Medicare Allowed Amount | 682617.25 |
| Total Medical Medicare Payment Amount | 510013.43 |
| Total Medical Medicare Standardized Payment Amount | 525890.03 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 315 |
| Number Of Beneficiaries Age 65 to 74 | 776 |
| Number Of Beneficiaries Age 75 to 84 | 636 |
| Number Of Beneficiaries Age Greater 84 | 374 |
| Number Of Female Beneficiaries | 1013 |
| Number Of Male Beneficiaries | 1088 |
| Number Of Non Hispanic White Beneficiaries | 1841 |
| Number Of Black or African American Beneficiaries | 194 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 39 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1550 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 551 |
| Percent Of With Atrial Fibrillation | 24 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 35 |
| Percent Of With Chronic Kidney Disease | 43 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 27 |
| Percent Of With Depression | 25 |
| Percent Of With Diabetes | 42 |
| Percent Of With Hyperlipidemia | 74 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 71 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 48 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.8176 |