| National Provider Identifier [NPI]: | 1548331812 |
| Last Name Of The Provider | ELISON |
| First Name Of The Provider | VIEDRA |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 14823 W BELL RD |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | SURPRISE |
| Zip Code Of The Provider | 853747607 |
| State Code Of The Provider | AZ |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 65 |
| Number Of Services | 6528 |
| Number Of Medicare Beneficiaries | 788 |
| Total Submitted Charge Amount | 486513 |
| Total Medicare Allowed Amount | 350432.38 |
| Total Medicare Payment Amount | 257594.52 |
| Total Medicare Standardized Payment Amount | 258189.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 232 |
| Number Of Medicare Beneficiaries With Drug Services | 15 |
| Total Drug Submitted ChargeAmount | 16977 |
| Total Drug Medicare AllowedAmount | 12003.26 |
| Total Drug Medicare PaymentAmount | 9410.53 |
| Total Drug Medicare Standardized Payment Amount | 9410.53 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 60 |
| Number Of Medical Services | 6296 |
| Number Of Medicare Beneficiaries With Medical Services | 788 |
| Total Medical Submitted Charge Amount | 469536 |
| Total Medical Medicare Allowed Amount | 338429.12 |
| Total Medical Medicare Payment Amount | 248183.99 |
| Total Medical Medicare Standardized Payment Amount | 248778.85 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 28 |
| Number Of Beneficiaries Age 65 to 74 | 365 |
| Number Of Beneficiaries Age 75 to 84 | 278 |
| Number Of Beneficiaries Age Greater 84 | 117 |
| Number Of Female Beneficiaries | 424 |
| Number Of Male Beneficiaries | 364 |
| Number Of Non Hispanic White Beneficiaries | 707 |
| Number Of Black or African American Beneficiaries | 27 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 32 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 775 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 13 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 15 |
| Percent Of With Chronic Kidney Disease | 28 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 17 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 10 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.3492 |