| National Provider Identifier [NPI]: | 1184691859 |
| Last Name Of The Provider | WEATHERLY |
| First Name Of The Provider | DANIELA |
| Middle Initial Of The Provider | V |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6001 AIRPORT BLVD |
| Street Address 2 Of The Provider | MOBILE MEDICAL GROUP |
| City Of The Provider | MOBILE |
| Zip Code Of The Provider | 366083142 |
| State Code Of The Provider | AL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 71 |
| Number Of Services | 2451 |
| Number Of Medicare Beneficiaries | 271 |
| Total Submitted Charge Amount | 106518 |
| Total Medicare Allowed Amount | 74104.3 |
| Total Medicare Payment Amount | 51809.9 |
| Total Medicare Standardized Payment Amount | 57435.3 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 102 |
| Number Of Medicare Beneficiaries With Drug Services | 54 |
| Total Drug Submitted ChargeAmount | 2530 |
| Total Drug Medicare AllowedAmount | 1165.01 |
| Total Drug Medicare PaymentAmount | 1095.35 |
| Total Drug Medicare Standardized Payment Amount | 1095.35 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 66 |
| Number Of Medical Services | 2349 |
| Number Of Medicare Beneficiaries With Medical Services | 271 |
| Total Medical Submitted Charge Amount | 103988 |
| Total Medical Medicare Allowed Amount | 72939.29 |
| Total Medical Medicare Payment Amount | 50714.55 |
| Total Medical Medicare Standardized Payment Amount | 56339.95 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 53 |
| Number Of Beneficiaries Age 65 to 74 | 123 |
| Number Of Beneficiaries Age 75 to 84 | 58 |
| Number Of Beneficiaries Age Greater 84 | 37 |
| Number Of Female Beneficiaries | 186 |
| Number Of Male Beneficiaries | 85 |
| Number Of Non Hispanic White Beneficiaries | 196 |
| 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 | 245 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 26 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 15 |
| Percent Of With Depression | 19 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 39 |
| Percent Of With Hypertension | 62 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.1689 |