| National Provider Identifier [NPI]: | 1699878124 |
| Last Name Of The Provider | SIMON |
| First Name Of The Provider | PERNELL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 207 WESTMARK BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAFAYETTE |
| Zip Code Of The Provider | 705067365 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 64 |
| Number Of Services | 3193 |
| Number Of Medicare Beneficiaries | 391 |
| Total Submitted Charge Amount | 126707 |
| Total Medicare Allowed Amount | 60612.51 |
| Total Medicare Payment Amount | 38070.75 |
| Total Medicare Standardized Payment Amount | 42387.15 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 12 |
| Number Of Drug Services | 2001 |
| Number Of Medicare Beneficiaries With Drug Services | 214 |
| Total Drug Submitted ChargeAmount | 21675 |
| Total Drug Medicare AllowedAmount | 3760.82 |
| Total Drug Medicare PaymentAmount | 2551.84 |
| Total Drug Medicare Standardized Payment Amount | 2551.84 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 52 |
| Number Of Medical Services | 1192 |
| Number Of Medicare Beneficiaries With Medical Services | 391 |
| Total Medical Submitted Charge Amount | 105032 |
| Total Medical Medicare Allowed Amount | 56851.69 |
| Total Medical Medicare Payment Amount | 35518.91 |
| Total Medical Medicare Standardized Payment Amount | 39835.31 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 53 |
| Number Of Beneficiaries Age 65 to 74 | 205 |
| Number Of Beneficiaries Age 75 to 84 | 101 |
| Number Of Beneficiaries Age Greater 84 | 32 |
| Number Of Female Beneficiaries | 245 |
| Number Of Male Beneficiaries | 146 |
| Number Of Non Hispanic White Beneficiaries | 345 |
| Number Of Black or African American Beneficiaries | 25 |
| 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 | 346 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 45 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 10 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 18 |
| Percent Of With Diabetes | 21 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.8238 |