| National Provider Identifier [NPI]: | 1588633952 |
| Last Name Of The Provider | SELO |
| First Name Of The Provider | RICHARD |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1345 UNITY PL |
| Street Address 2 Of The Provider | SUITE 110 |
| City Of The Provider | LAFAYETTE |
| Zip Code Of The Provider | 479055768 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Urology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 94 |
| Number Of Services | 16360 |
| Number Of Medicare Beneficiaries | 932 |
| Total Submitted Charge Amount | 1440472 |
| Total Medicare Allowed Amount | 383714.49 |
| Total Medicare Payment Amount | 288778.86 |
| Total Medicare Standardized Payment Amount | 304252.83 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 12934 |
| Number Of Medicare Beneficiaries With Drug Services | 44 |
| Total Drug Submitted ChargeAmount | 388360 |
| Total Drug Medicare AllowedAmount | 127658.77 |
| Total Drug Medicare PaymentAmount | 99000.01 |
| Total Drug Medicare Standardized Payment Amount | 99000.01 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 87 |
| Number Of Medical Services | 3426 |
| Number Of Medicare Beneficiaries With Medical Services | 932 |
| Total Medical Submitted Charge Amount | 1052112 |
| Total Medical Medicare Allowed Amount | 256055.72 |
| Total Medical Medicare Payment Amount | 189778.85 |
| Total Medical Medicare Standardized Payment Amount | 205252.82 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 74 |
| Number Of Beneficiaries Age 65 to 74 | 415 |
| Number Of Beneficiaries Age 75 to 84 | 300 |
| Number Of Beneficiaries Age Greater 84 | 143 |
| Number Of Female Beneficiaries | 243 |
| Number Of Male Beneficiaries | 689 |
| Number Of Non Hispanic White Beneficiaries | 899 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 12 |
| Number Of Beneficiaries With Medicare Only Entitlement | 818 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 114 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 23 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 38 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 19 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 33 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 39 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.3123 |