| National Provider Identifier [NPI]: | 1942333075 |
| Last Name Of The Provider | DALSTROM |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9850 GENESEE AVENUE |
| Street Address 2 Of The Provider | SUITE 210 |
| City Of The Provider | LA JOLLA |
| Zip Code Of The Provider | 92037 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 103 |
| Number Of Services | 1531 |
| Number Of Medicare Beneficiaries | 337 |
| Total Submitted Charge Amount | 320727 |
| Total Medicare Allowed Amount | 123965.68 |
| Total Medicare Payment Amount | 92493.26 |
| Total Medicare Standardized Payment Amount | 92857.18 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 377 |
| Number Of Medicare Beneficiaries With Drug Services | 59 |
| Total Drug Submitted ChargeAmount | 7280 |
| Total Drug Medicare AllowedAmount | 3835.36 |
| Total Drug Medicare PaymentAmount | 2979.8 |
| Total Drug Medicare Standardized Payment Amount | 2979.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 100 |
| Number Of Medical Services | 1154 |
| Number Of Medicare Beneficiaries With Medical Services | 337 |
| Total Medical Submitted Charge Amount | 313447 |
| Total Medical Medicare Allowed Amount | 120130.32 |
| Total Medical Medicare Payment Amount | 89513.46 |
| Total Medical Medicare Standardized Payment Amount | 89877.38 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 24 |
| Number Of Beneficiaries Age 65 to 74 | 152 |
| Number Of Beneficiaries Age 75 to 84 | 111 |
| Number Of Beneficiaries Age Greater 84 | 50 |
| Number Of Female Beneficiaries | 239 |
| Number Of Male Beneficiaries | 98 |
| Number Of Non Hispanic White Beneficiaries | 310 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 12 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 310 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 27 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 17 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 61 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.1695 |