| National Provider Identifier [NPI]: | 1184606097 |
| Last Name Of The Provider | REVUELTA |
| First Name Of The Provider | MANUEL |
| 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 | 2780 CLEVELAND AVE |
| Street Address 2 Of The Provider | SUITE 809 |
| City Of The Provider | FORT MYERS |
| Zip Code Of The Provider | 339015817 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 18 |
| Number Of Services | 2027 |
| Number Of Medicare Beneficiaries | 474 |
| Total Submitted Charge Amount | 448603 |
| Total Medicare Allowed Amount | 187805.32 |
| Total Medicare Payment Amount | 145751.7 |
| Total Medicare Standardized Payment Amount | 139292.98 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 22 |
| Number Of Medicare Beneficiaries With Drug Services | 20 |
| Total Drug Submitted ChargeAmount | 2062 |
| Total Drug Medicare AllowedAmount | 901.78 |
| Total Drug Medicare PaymentAmount | 883.72 |
| Total Drug Medicare Standardized Payment Amount | 883.72 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 14 |
| Number Of Medical Services | 2005 |
| Number Of Medicare Beneficiaries With Medical Services | 474 |
| Total Medical Submitted Charge Amount | 446541 |
| Total Medical Medicare Allowed Amount | 186903.54 |
| Total Medical Medicare Payment Amount | 144867.98 |
| Total Medical Medicare Standardized Payment Amount | 138409.26 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 138 |
| Number Of Beneficiaries Age 65 to 74 | 148 |
| Number Of Beneficiaries Age 75 to 84 | 115 |
| Number Of Beneficiaries Age Greater 84 | 73 |
| Number Of Female Beneficiaries | 213 |
| Number Of Male Beneficiaries | 261 |
| Number Of Non Hispanic White Beneficiaries | 383 |
| Number Of Black or African American Beneficiaries | 51 |
| 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 | 288 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 186 |
| Percent Of With Atrial Fibrillation | 23 |
| Percent Of With Alzheimers Disease or Dementia | 26 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 19 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 56 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 38 |
| Percent Of With Depression | 41 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.4962 |