| National Provider Identifier [NPI]: | 1457308850 |
| Last Name Of The Provider | DOMANGUE |
| First Name Of The Provider | LEE |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 100 MEDICAL CENTER DRIVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | SLIDELL |
| Zip Code Of The Provider | 704615520 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 16 |
| Number Of Services | 397 |
| Number Of Medicare Beneficiaries | 315 |
| Total Submitted Charge Amount | 541629 |
| Total Medicare Allowed Amount | 59996.2 |
| Total Medicare Payment Amount | 45879.66 |
| Total Medicare Standardized Payment Amount | 47238.21 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 16 |
| Number Of Medical Services | 397 |
| Number Of Medicare Beneficiaries With Medical Services | 315 |
| Total Medical Submitted Charge Amount | 541629 |
| Total Medical Medicare Allowed Amount | 59996.2 |
| Total Medical Medicare Payment Amount | 45879.66 |
| Total Medical Medicare Standardized Payment Amount | 47238.21 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 99 |
| Number Of Beneficiaries Age 65 to 74 | 103 |
| Number Of Beneficiaries Age 75 to 84 | 72 |
| Number Of Beneficiaries Age Greater 84 | 41 |
| Number Of Female Beneficiaries | 201 |
| Number Of Male Beneficiaries | 114 |
| Number Of Non Hispanic White Beneficiaries | 233 |
| Number Of Black or African American Beneficiaries | 68 |
| 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 | 183 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 132 |
| Percent Of With Atrial Fibrillation | 21 |
| Percent Of With Alzheimers Disease or Dementia | 25 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 41 |
| Percent Of With Chronic Kidney Disease | 47 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 40 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 61 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 53 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 12 |
| Percent Of With Stroke | 12 |
| Average HCC Risk Score Of Beneficiaries | 2.4701 |