| National Provider Identifier [NPI]: | 1326155102 |
| Last Name Of The Provider | CASTILLO |
| First Name Of The Provider | GABRIELLA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 422 POPLAR ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | TERRE HAUTE |
| Zip Code Of The Provider | 478074209 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 85 |
| Number Of Services | 5288 |
| Number Of Medicare Beneficiaries | 1336 |
| Total Submitted Charge Amount | 521430 |
| Total Medicare Allowed Amount | 245104.15 |
| Total Medicare Payment Amount | 180121.14 |
| Total Medicare Standardized Payment Amount | 189551.68 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 809 |
| Number Of Medicare Beneficiaries With Drug Services | 104 |
| Total Drug Submitted ChargeAmount | 3236 |
| Total Drug Medicare AllowedAmount | 1457.63 |
| Total Drug Medicare PaymentAmount | 1055.56 |
| Total Drug Medicare Standardized Payment Amount | 1055.56 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 83 |
| Number Of Medical Services | 4479 |
| Number Of Medicare Beneficiaries With Medical Services | 1336 |
| Total Medical Submitted Charge Amount | 518194 |
| Total Medical Medicare Allowed Amount | 243646.52 |
| Total Medical Medicare Payment Amount | 179065.58 |
| Total Medical Medicare Standardized Payment Amount | 188496.12 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 89 |
| Number Of Beneficiaries Age 65 to 74 | 564 |
| Number Of Beneficiaries Age 75 to 84 | 445 |
| Number Of Beneficiaries Age Greater 84 | 238 |
| Number Of Female Beneficiaries | 688 |
| Number Of Male Beneficiaries | 648 |
| Number Of Non Hispanic White Beneficiaries | 1310 |
| 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 | 1219 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 117 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 14 |
| Percent Of With Diabetes | 28 |
| Percent Of With Hyperlipidemia | 50 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 42 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.0745 |