| National Provider Identifier [NPI]: | 1912166786 |
| Last Name Of The Provider | DELISSER |
| First Name Of The Provider | KEMESHA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3803 FAIRFAX DR |
| Street Address 2 Of The Provider | STE 400 |
| City Of The Provider | ARLINGTON |
| Zip Code Of The Provider | 222035860 |
| State Code Of The Provider | VA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 59 |
| Number Of Services | 5755 |
| Number Of Medicare Beneficiaries | 435 |
| Total Submitted Charge Amount | 2205071 |
| Total Medicare Allowed Amount | 515505.41 |
| Total Medicare Payment Amount | 390401.93 |
| Total Medicare Standardized Payment Amount | 317510.87 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 3012 |
| Number Of Medicare Beneficiaries With Drug Services | 313 |
| Total Drug Submitted ChargeAmount | 117916 |
| Total Drug Medicare AllowedAmount | 8778.08 |
| Total Drug Medicare PaymentAmount | 6770.6 |
| Total Drug Medicare Standardized Payment Amount | 6770.6 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 50 |
| Number Of Medical Services | 2743 |
| Number Of Medicare Beneficiaries With Medical Services | 435 |
| Total Medical Submitted Charge Amount | 2087155 |
| Total Medical Medicare Allowed Amount | 506727.33 |
| Total Medical Medicare Payment Amount | 383631.33 |
| Total Medical Medicare Standardized Payment Amount | 310740.27 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 97 |
| Number Of Beneficiaries Age 65 to 74 | 169 |
| Number Of Beneficiaries Age 75 to 84 | 99 |
| Number Of Beneficiaries Age Greater 84 | 70 |
| Number Of Female Beneficiaries | 291 |
| Number Of Male Beneficiaries | 144 |
| Number Of Non Hispanic White Beneficiaries | 323 |
| Number Of Black or African American Beneficiaries | 79 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 21 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 373 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 62 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 12 |
| Percent Of With Chronic Kidney Disease | 15 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 27 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 63 |
| Percent Of With Ischemic Heart Disease | 23 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.2547 |