| National Provider Identifier [NPI]: | 1184684888 |
| Last Name Of The Provider | GLASS |
| First Name Of The Provider | DALE |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1600 UNIVERSITY DR E |
| Street Address 2 Of The Provider | |
| City Of The Provider | COLLEGE STATION |
| Zip Code Of The Provider | 778402642 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Diagnostic Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 123 |
| Number Of Services | 3670 |
| Number Of Medicare Beneficiaries | 2252 |
| Total Submitted Charge Amount | 346758 |
| Total Medicare Allowed Amount | 83560.96 |
| Total Medicare Payment Amount | 65170.57 |
| Total Medicare Standardized Payment Amount | 68151.36 |
| 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 | 123 |
| Number Of Medical Services | 3670 |
| Number Of Medicare Beneficiaries With Medical Services | 2252 |
| Total Medical Submitted Charge Amount | 346758 |
| Total Medical Medicare Allowed Amount | 83560.96 |
| Total Medical Medicare Payment Amount | 65170.57 |
| Total Medical Medicare Standardized Payment Amount | 68151.36 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 322 |
| Number Of Beneficiaries Age 65 to 74 | 945 |
| Number Of Beneficiaries Age 75 to 84 | 693 |
| Number Of Beneficiaries Age Greater 84 | 292 |
| Number Of Female Beneficiaries | 1538 |
| Number Of Male Beneficiaries | 714 |
| Number Of Non Hispanic White Beneficiaries | 1773 |
| Number Of Black or African American Beneficiaries | 307 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 140 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 16 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1864 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 388 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 30 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 74 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.2641 |