| National Provider Identifier [NPI]: | 1609801489 |
| Last Name Of The Provider | GALLO |
| First Name Of The Provider | SAMUEL |
| 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 | 6620 PERIMETER DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | DUBLIN |
| Zip Code Of The Provider | 430168055 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Ophthalmology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 58 |
| Number Of Services | 5243 |
| Number Of Medicare Beneficiaries | 335 |
| Total Submitted Charge Amount | 943944 |
| Total Medicare Allowed Amount | 262678.92 |
| Total Medicare Payment Amount | 203356.08 |
| Total Medicare Standardized Payment Amount | 195689.5 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 1 |
| Number Of Drug Services | 4200 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 42000 |
| Total Drug Medicare AllowedAmount | 21935.6 |
| Total Drug Medicare PaymentAmount | 17162.43 |
| Total Drug Medicare Standardized Payment Amount | 17162.43 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 57 |
| Number Of Medical Services | 1043 |
| Number Of Medicare Beneficiaries With Medical Services | 335 |
| Total Medical Submitted Charge Amount | 901944 |
| Total Medical Medicare Allowed Amount | 240743.32 |
| Total Medical Medicare Payment Amount | 186193.65 |
| Total Medical Medicare Standardized Payment Amount | 178527.07 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 40 |
| Number Of Beneficiaries Age 65 to 74 | 160 |
| Number Of Beneficiaries Age 75 to 84 | 88 |
| Number Of Beneficiaries Age Greater 84 | 47 |
| Number Of Female Beneficiaries | 228 |
| Number Of Male Beneficiaries | 107 |
| Number Of Non Hispanic White Beneficiaries | 306 |
| Number Of Black or African American Beneficiaries | |
| 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 | 276 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 59 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 16 |
| Percent Of With Chronic Kidney Disease | 20 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 16 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1944 |