| National Provider Identifier [NPI]: | 1104931575 |
| Last Name Of The Provider | BURGESS |
| First Name Of The Provider | DARYL |
| Middle Initial Of The Provider | W |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 215 PESETAS LN |
| Street Address 2 Of The Provider | |
| City Of The Provider | SANTA BARBARA |
| Zip Code Of The Provider | 931101416 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 59 |
| Number Of Services | 1802 |
| Number Of Medicare Beneficiaries | 255 |
| Total Submitted Charge Amount | 138529 |
| Total Medicare Allowed Amount | 73987.73 |
| Total Medicare Payment Amount | 50565.99 |
| Total Medicare Standardized Payment Amount | 49382.66 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 15 |
| Number Of Drug Services | 1029 |
| Number Of Medicare Beneficiaries With Drug Services | 41 |
| Total Drug Submitted ChargeAmount | 9288 |
| Total Drug Medicare AllowedAmount | 3758.12 |
| Total Drug Medicare PaymentAmount | 3275.19 |
| Total Drug Medicare Standardized Payment Amount | 3275.19 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 44 |
| Number Of Medical Services | 773 |
| Number Of Medicare Beneficiaries With Medical Services | 255 |
| Total Medical Submitted Charge Amount | 129241 |
| Total Medical Medicare Allowed Amount | 70229.61 |
| Total Medical Medicare Payment Amount | 47290.8 |
| Total Medical Medicare Standardized Payment Amount | 46107.47 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 38 |
| Number Of Beneficiaries Age 65 to 74 | 108 |
| Number Of Beneficiaries Age 75 to 84 | 73 |
| Number Of Beneficiaries Age Greater 84 | 36 |
| Number Of Female Beneficiaries | 119 |
| Number Of Male Beneficiaries | 136 |
| Number Of Non Hispanic White Beneficiaries | 185 |
| Number Of Black or African American Beneficiaries | 13 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 44 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 218 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 37 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 20 |
| Percent Of With Diabetes | 41 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 27 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1949 |