| National Provider Identifier [NPI]: | 1427075308 |
| Last Name Of The Provider | SA |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3201 S LOOP 256 |
| Street Address 2 Of The Provider | |
| City Of The Provider | PALESTINE |
| Zip Code Of The Provider | 758016901 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Neurology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 34 |
| Number Of Services | 12879 |
| Number Of Medicare Beneficiaries | 412 |
| Total Submitted Charge Amount | 470792 |
| Total Medicare Allowed Amount | 192396.82 |
| Total Medicare Payment Amount | 141326.5 |
| Total Medicare Standardized Payment Amount | 144826.54 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 11850 |
| Number Of Medicare Beneficiaries With Drug Services | 25 |
| Total Drug Submitted ChargeAmount | 127900 |
| Total Drug Medicare AllowedAmount | 69988 |
| Total Drug Medicare PaymentAmount | 54424.24 |
| Total Drug Medicare Standardized Payment Amount | 54424.24 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 31 |
| Number Of Medical Services | 1029 |
| Number Of Medicare Beneficiaries With Medical Services | 412 |
| Total Medical Submitted Charge Amount | 342892 |
| Total Medical Medicare Allowed Amount | 122408.82 |
| Total Medical Medicare Payment Amount | 86902.26 |
| Total Medical Medicare Standardized Payment Amount | 90402.3 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 79 |
| Number Of Beneficiaries Age 65 to 74 | 151 |
| Number Of Beneficiaries Age 75 to 84 | 128 |
| Number Of Beneficiaries Age Greater 84 | 54 |
| Number Of Female Beneficiaries | 214 |
| Number Of Male Beneficiaries | 198 |
| Number Of Non Hispanic White Beneficiaries | 397 |
| 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 | 298 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 114 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 24 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 29 |
| Percent Of With Hyperlipidemia | 62 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 23 |
| Average HCC Risk Score Of Beneficiaries | 1.5655 |