| National Provider Identifier [NPI]: | 1336134402 |
| Last Name Of The Provider | DESALVO |
| First Name Of The Provider | JOHN |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5454 HOHMAN AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | HAMMOND |
| Zip Code Of The Provider | 463201931 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 833 |
| Number Of Medicare Beneficiaries | 753 |
| Total Submitted Charge Amount | 375393 |
| Total Medicare Allowed Amount | 103200.94 |
| Total Medicare Payment Amount | 80278.4 |
| Total Medicare Standardized Payment Amount | 83528.41 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 21 |
| Number Of Medical Services | 833 |
| Number Of Medicare Beneficiaries With Medical Services | 753 |
| Total Medical Submitted Charge Amount | 375393 |
| Total Medical Medicare Allowed Amount | 103200.94 |
| Total Medical Medicare Payment Amount | 80278.4 |
| Total Medical Medicare Standardized Payment Amount | 83528.41 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 192 |
| Number Of Beneficiaries Age 65 to 74 | 207 |
| Number Of Beneficiaries Age 75 to 84 | 198 |
| Number Of Beneficiaries Age Greater 84 | 156 |
| Number Of Female Beneficiaries | 431 |
| Number Of Male Beneficiaries | 322 |
| Number Of Non Hispanic White Beneficiaries | 466 |
| Number Of Black or African American Beneficiaries | 219 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 463 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 290 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 49 |
| Percent Of With Chronic Kidney Disease | 45 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 39 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 63 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 2.2966 |