| National Provider Identifier [NPI]: | 1821090556 |
| Last Name Of The Provider | MALLORY |
| First Name Of The Provider | DAVID |
| 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 | 3740 W SYLVANIA AVE |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | TOLEDO |
| Zip Code Of The Provider | 436234461 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 41 |
| Number Of Services | 1048 |
| Number Of Medicare Beneficiaries | 325 |
| Total Submitted Charge Amount | 90359 |
| Total Medicare Allowed Amount | 67612.33 |
| Total Medicare Payment Amount | 46542.55 |
| Total Medicare Standardized Payment Amount | 49253.45 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 201 |
| Number Of Medicare Beneficiaries With Drug Services | 150 |
| Total Drug Submitted ChargeAmount | 8062 |
| Total Drug Medicare AllowedAmount | 5069.21 |
| Total Drug Medicare PaymentAmount | 4798.08 |
| Total Drug Medicare Standardized Payment Amount | 4798.08 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 847 |
| Number Of Medicare Beneficiaries With Medical Services | 325 |
| Total Medical Submitted Charge Amount | 82297 |
| Total Medical Medicare Allowed Amount | 62543.12 |
| Total Medical Medicare Payment Amount | 41744.47 |
| Total Medical Medicare Standardized Payment Amount | 44455.37 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 24 |
| Number Of Beneficiaries Age 65 to 74 | 134 |
| Number Of Beneficiaries Age 75 to 84 | 89 |
| Number Of Beneficiaries Age Greater 84 | 78 |
| Number Of Female Beneficiaries | 154 |
| Number Of Male Beneficiaries | 171 |
| Number Of Non Hispanic White Beneficiaries | 309 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| 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 | 302 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 23 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 33 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0333 |