| National Provider Identifier [NPI]: | 1679748537 |
| Last Name Of The Provider | ADAM |
| First Name Of The Provider | IAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MS, MD, FACP |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 5323 GRAND BLVD |
| Street Address 2 Of The Provider | |
| City Of The Provider | NEW PORT RICHEY |
| Zip Code Of The Provider | 346524013 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 26 |
| Number Of Services | 296 |
| Number Of Medicare Beneficiaries | 75 |
| Total Submitted Charge Amount | 45220 |
| Total Medicare Allowed Amount | 23854.04 |
| Total Medicare Payment Amount | 17574.82 |
| Total Medicare Standardized Payment Amount | 17643.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 38 |
| Number Of Medicare Beneficiaries With Drug Services | 31 |
| Total Drug Submitted ChargeAmount | 1461 |
| Total Drug Medicare AllowedAmount | 888.82 |
| Total Drug Medicare PaymentAmount | 868.78 |
| Total Drug Medicare Standardized Payment Amount | 868.78 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 20 |
| Number Of Medical Services | 258 |
| Number Of Medicare Beneficiaries With Medical Services | 75 |
| Total Medical Submitted Charge Amount | 43759 |
| Total Medical Medicare Allowed Amount | 22965.22 |
| Total Medical Medicare Payment Amount | 16706.04 |
| Total Medical Medicare Standardized Payment Amount | 16774.6 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 23 |
| Number Of Beneficiaries Age 75 to 84 | 34 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 37 |
| Number Of Male Beneficiaries | 38 |
| Number Of Non Hispanic White Beneficiaries | |
| 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 | |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | 15 |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 25 |
| Percent Of With Chronic Kidney Disease | 57 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 44 |
| Percent Of With Hyperlipidemia | 75 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.5006 |