| National Provider Identifier [NPI]: | 1326050485 |
| Last Name Of The Provider | ALLEN |
| First Name Of The Provider | ROOSEVELT |
| 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 | 500 MEDICAL CENTER BLVD |
| Street Address 2 Of The Provider | SUITE 220 |
| City Of The Provider | LAWRENCEVILLE |
| Zip Code Of The Provider | 30046 |
| 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 | 79 |
| Number Of Services | 2612 |
| Number Of Medicare Beneficiaries | 575 |
| Total Submitted Charge Amount | 910213 |
| Total Medicare Allowed Amount | 426570.07 |
| Total Medicare Payment Amount | 326006.27 |
| Total Medicare Standardized Payment Amount | 327833.32 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 389 |
| Number Of Medicare Beneficiaries With Drug Services | 34 |
| Total Drug Submitted ChargeAmount | 391104 |
| Total Drug Medicare AllowedAmount | 250076.23 |
| Total Drug Medicare PaymentAmount | 195834.06 |
| Total Drug Medicare Standardized Payment Amount | 195834.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 71 |
| Number Of Medical Services | 2223 |
| Number Of Medicare Beneficiaries With Medical Services | 572 |
| Total Medical Submitted Charge Amount | 519109 |
| Total Medical Medicare Allowed Amount | 176493.84 |
| Total Medical Medicare Payment Amount | 130172.21 |
| Total Medical Medicare Standardized Payment Amount | 131999.26 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 46 |
| Number Of Beneficiaries Age 65 to 74 | 289 |
| Number Of Beneficiaries Age 75 to 84 | 175 |
| Number Of Beneficiaries Age Greater 84 | 65 |
| Number Of Female Beneficiaries | 151 |
| Number Of Male Beneficiaries | 424 |
| Number Of Non Hispanic White Beneficiaries | 421 |
| Number Of Black or African American Beneficiaries | 112 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 17 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 516 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 59 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 25 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 31 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.2276 |