| National Provider Identifier [NPI]: | 1578501243 |
| Last Name Of The Provider | GALLANT |
| First Name Of The Provider | JOEL |
| Middle Initial Of The Provider | E |
| Credentials Of The Provider | M.D., M.P.H. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 649 HARKLE RD |
| Street Address 2 Of The Provider | SUITE E |
| City Of The Provider | SANTA FE |
| Zip Code Of The Provider | 875054765 |
| State Code Of The Provider | NM |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Infectious Disease |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 39 |
| Number Of Services | 4291 |
| Number Of Medicare Beneficiaries | 183 |
| Total Submitted Charge Amount | 72984.24 |
| Total Medicare Allowed Amount | 45772.93 |
| Total Medicare Payment Amount | 34525.04 |
| Total Medicare Standardized Payment Amount | 35754.39 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 3653 |
| Number Of Medicare Beneficiaries With Drug Services | 68 |
| Total Drug Submitted ChargeAmount | 15061 |
| Total Drug Medicare AllowedAmount | 10021.24 |
| Total Drug Medicare PaymentAmount | 9347.27 |
| Total Drug Medicare Standardized Payment Amount | 9347.27 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 30 |
| Number Of Medical Services | 638 |
| Number Of Medicare Beneficiaries With Medical Services | 183 |
| Total Medical Submitted Charge Amount | 57923.24 |
| Total Medical Medicare Allowed Amount | 35751.69 |
| Total Medical Medicare Payment Amount | 25177.77 |
| Total Medical Medicare Standardized Payment Amount | 26407.12 |
| Average Age Of Beneficiaries | 58 |
| Number Of Beneficiaries Age Less65 | 123 |
| Number Of Beneficiaries Age 65 to 74 | 47 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 32 |
| Number Of Male Beneficiaries | 151 |
| Number Of Non Hispanic White Beneficiaries | 113 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 56 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 91 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 92 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 44 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 30 |
| Percent Of With Hypertension | 35 |
| Percent Of With Ischemic Heart Disease | 6 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 29 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2307 |