| National Provider Identifier [NPI]: | 1255381950 |
| Last Name Of The Provider | VACALA |
| First Name Of The Provider | MARY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | P.A. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4425 PAULSEN ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAVANNAH |
| Zip Code Of The Provider | 314053637 |
| State Code Of The Provider | GA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physician Assistant |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 44 |
| Number Of Services | 712 |
| Number Of Medicare Beneficiaries | 217 |
| Total Submitted Charge Amount | 108572 |
| Total Medicare Allowed Amount | 31521.39 |
| Total Medicare Payment Amount | 22311.31 |
| Total Medicare Standardized Payment Amount | 26903.71 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 224 |
| Number Of Medicare Beneficiaries With Drug Services | 92 |
| Total Drug Submitted ChargeAmount | 18777 |
| Total Drug Medicare AllowedAmount | 6965.03 |
| Total Drug Medicare PaymentAmount | 4927.85 |
| Total Drug Medicare Standardized Payment Amount | 4927.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 488 |
| Number Of Medicare Beneficiaries With Medical Services | 216 |
| Total Medical Submitted Charge Amount | 89795 |
| Total Medical Medicare Allowed Amount | 24556.36 |
| Total Medical Medicare Payment Amount | 17383.46 |
| Total Medical Medicare Standardized Payment Amount | 21975.86 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 27 |
| Number Of Beneficiaries Age 65 to 74 | 109 |
| Number Of Beneficiaries Age 75 to 84 | 61 |
| Number Of Beneficiaries Age Greater 84 | 20 |
| Number Of Female Beneficiaries | 130 |
| Number Of Male Beneficiaries | 87 |
| Number Of Non Hispanic White Beneficiaries | 166 |
| Number Of Black or African American Beneficiaries | |
| 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 | 192 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 25 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 16 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 22 |
| Percent Of With Diabetes | 23 |
| Percent Of With Hyperlipidemia | 70 |
| Percent Of With Hypertension | 71 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 70 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.9037 |