| National Provider Identifier [NPI]: | 1013015247 |
| Last Name Of The Provider | FOLGOSA |
| First Name Of The Provider | MAURO |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 290 COUNTRY CLUB DR |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | STOCKBRIDGE |
| Zip Code Of The Provider | 302819069 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 91 |
| Number Of Services | 9122 |
| Number Of Medicare Beneficiaries | 820 |
| Total Submitted Charge Amount | 1473343.2 |
| Total Medicare Allowed Amount | 450443.75 |
| Total Medicare Payment Amount | 335274.09 |
| Total Medicare Standardized Payment Amount | 346215.26 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 2344 |
| Number Of Medicare Beneficiaries With Drug Services | 96 |
| Total Drug Submitted ChargeAmount | 118512.7 |
| Total Drug Medicare AllowedAmount | 34044.31 |
| Total Drug Medicare PaymentAmount | 25864.22 |
| Total Drug Medicare Standardized Payment Amount | 25864.22 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 81 |
| Number Of Medical Services | 6778 |
| Number Of Medicare Beneficiaries With Medical Services | 820 |
| Total Medical Submitted Charge Amount | 1354830.5 |
| Total Medical Medicare Allowed Amount | 416399.44 |
| Total Medical Medicare Payment Amount | 309409.87 |
| Total Medical Medicare Standardized Payment Amount | 320351.04 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 105 |
| Number Of Beneficiaries Age 65 to 74 | 379 |
| Number Of Beneficiaries Age 75 to 84 | 246 |
| Number Of Beneficiaries Age Greater 84 | 90 |
| Number Of Female Beneficiaries | 280 |
| Number Of Male Beneficiaries | 540 |
| Number Of Non Hispanic White Beneficiaries | 625 |
| Number Of Black or African American Beneficiaries | 145 |
| Number Of AsianPacific Islander Beneficiaries | 12 |
| Number Of Hispanic Beneficiaries | 27 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 11 |
| Number Of Beneficiaries With Medicare Only Entitlement | 712 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 108 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 24 |
| Percent Of With Heart Failure | 13 |
| Percent Of With Chronic Kidney Disease | 33 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.1875 |