| National Provider Identifier [NPI]: | 1750368726 |
| Last Name Of The Provider | SIMALA |
| First Name Of The Provider | DAWN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 60101 BODNER DR |
| Street Address 2 Of The Provider | SUITE 100B |
| City Of The Provider | MISHAWAKA |
| Zip Code Of The Provider | 465449340 |
| State Code Of The Provider | IN |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 69 |
| Number Of Services | 2508 |
| Number Of Medicare Beneficiaries | 305 |
| Total Submitted Charge Amount | 262441.15 |
| Total Medicare Allowed Amount | 160149.17 |
| Total Medicare Payment Amount | 121074.7 |
| Total Medicare Standardized Payment Amount | 127834.95 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 455 |
| Number Of Medicare Beneficiaries With Drug Services | 71 |
| Total Drug Submitted ChargeAmount | 16077.4 |
| Total Drug Medicare AllowedAmount | 11959 |
| Total Drug Medicare PaymentAmount | 10583.36 |
| Total Drug Medicare Standardized Payment Amount | 10583.36 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 64 |
| Number Of Medical Services | 2053 |
| Number Of Medicare Beneficiaries With Medical Services | 305 |
| Total Medical Submitted Charge Amount | 246363.75 |
| Total Medical Medicare Allowed Amount | 148190.17 |
| Total Medical Medicare Payment Amount | 110491.34 |
| Total Medical Medicare Standardized Payment Amount | 117251.59 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 43 |
| Number Of Beneficiaries Age 65 to 74 | 124 |
| Number Of Beneficiaries Age 75 to 84 | 86 |
| Number Of Beneficiaries Age Greater 84 | 52 |
| Number Of Female Beneficiaries | 214 |
| Number Of Male Beneficiaries | 91 |
| Number Of Non Hispanic White Beneficiaries | 277 |
| Number Of Black or African American Beneficiaries | 15 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 245 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 60 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 20 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 50 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 10 |
| Average HCC Risk Score Of Beneficiaries | 1.2392 |