| National Provider Identifier [NPI]: | 1730166729 |
| Last Name Of The Provider | CAVALLARO |
| First Name Of The Provider | JAMES |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | PA-C |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6490 EXCELSIOR BLVD |
| Street Address 2 Of The Provider | STE E400 |
| City Of The Provider | ST LOUIS PARK |
| Zip Code Of The Provider | 554264705 |
| State Code Of The Provider | MN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 471 |
| Number Of Medicare Beneficiaries | 197 |
| Total Submitted Charge Amount | 70878.23 |
| Total Medicare Allowed Amount | 24706.31 |
| Total Medicare Payment Amount | 17594.58 |
| Total Medicare Standardized Payment Amount | 21413.62 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 134 |
| Number Of Medicare Beneficiaries With Drug Services | 63 |
| Total Drug Submitted ChargeAmount | 897 |
| Total Drug Medicare AllowedAmount | 391.97 |
| Total Drug Medicare PaymentAmount | 287.03 |
| Total Drug Medicare Standardized Payment Amount | 287.03 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 337 |
| Number Of Medicare Beneficiaries With Medical Services | 196 |
| Total Medical Submitted Charge Amount | 69981.23 |
| Total Medical Medicare Allowed Amount | 24314.34 |
| Total Medical Medicare Payment Amount | 17307.55 |
| Total Medical Medicare Standardized Payment Amount | 21126.59 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 47 |
| Number Of Beneficiaries Age 65 to 74 | 68 |
| Number Of Beneficiaries Age 75 to 84 | 57 |
| Number Of Beneficiaries Age Greater 84 | 25 |
| Number Of Female Beneficiaries | 122 |
| Number Of Male Beneficiaries | 75 |
| Number Of Non Hispanic White Beneficiaries | 177 |
| 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 | |
| Number Of Beneficiaries With Medicare Only Entitlement | 155 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 42 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 14 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 9 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 35 |
| Percent Of With Hypertension | 53 |
| Percent Of With Ischemic Heart Disease | 22 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.087 |