| National Provider Identifier [NPI]: | 1730346826 |
| Last Name Of The Provider | CRAIG |
| First Name Of The Provider | GAZELLE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 70 S MUNN AVE |
| Street Address 2 Of The Provider | # 610 |
| City Of The Provider | EAST ORANGE |
| Zip Code Of The Provider | 070184322 |
| State Code Of The Provider | NJ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | General Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 14 |
| Number Of Services | 292 |
| Number Of Medicare Beneficiaries | 20 |
| Total Submitted Charge Amount | 92890 |
| Total Medicare Allowed Amount | 28193.86 |
| Total Medicare Payment Amount | 22103.96 |
| Total Medicare Standardized Payment Amount | 16971.78 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 117 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 22865 |
| Total Drug Medicare AllowedAmount | 7985.54 |
| Total Drug Medicare PaymentAmount | 6260.57 |
| Total Drug Medicare Standardized Payment Amount | 6260.57 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 10 |
| Number Of Medical Services | 175 |
| Number Of Medicare Beneficiaries With Medical Services | 20 |
| Total Medical Submitted Charge Amount | 70025 |
| Total Medical Medicare Allowed Amount | 20208.32 |
| Total Medical Medicare Payment Amount | 15843.39 |
| Total Medical Medicare Standardized Payment Amount | 10711.21 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | |
| Number Of Male Beneficiaries | |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 0 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 0 |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | |
| Percent Of With Diabetes | 60 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 0 |
| Average HCC Risk Score Of Beneficiaries | 1.0176 |