| National Provider Identifier [NPI]: | 1639289838 |
| Last Name Of The Provider | SEVERANCE |
| First Name Of The Provider | DOUGLAS |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5601 NORRIS CANYON RD |
| Street Address 2 Of The Provider | 330 |
| City Of The Provider | SAN RAMON |
| Zip Code Of The Provider | 945835407 |
| 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 | 65 |
| Number Of Services | 2651 |
| Number Of Medicare Beneficiaries | 430 |
| Total Submitted Charge Amount | 247577 |
| Total Medicare Allowed Amount | 176197.01 |
| Total Medicare Payment Amount | 135911.91 |
| Total Medicare Standardized Payment Amount | 121128.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 466 |
| Number Of Medicare Beneficiaries With Drug Services | 235 |
| Total Drug Submitted ChargeAmount | 21144 |
| Total Drug Medicare AllowedAmount | 14389.81 |
| Total Drug Medicare PaymentAmount | 13584.65 |
| Total Drug Medicare Standardized Payment Amount | 13584.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 49 |
| Number Of Medical Services | 2185 |
| Number Of Medicare Beneficiaries With Medical Services | 430 |
| Total Medical Submitted Charge Amount | 226433 |
| Total Medical Medicare Allowed Amount | 161807.2 |
| Total Medical Medicare Payment Amount | 122327.26 |
| Total Medical Medicare Standardized Payment Amount | 107544.26 |
| Average Age Of Beneficiaries | 75 |
| Number Of Beneficiaries Age Less65 | 26 |
| Number Of Beneficiaries Age 65 to 74 | 215 |
| Number Of Beneficiaries Age 75 to 84 | 106 |
| Number Of Beneficiaries Age Greater 84 | 83 |
| Number Of Female Beneficiaries | 228 |
| Number Of Male Beneficiaries | 202 |
| Number Of Non Hispanic White Beneficiaries | 376 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 20 |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 413 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 5 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 17 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 8 |
| Percent Of With Depression | 11 |
| Percent Of With Diabetes | 18 |
| Percent Of With Hyperlipidemia | 48 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8974 |