| National Provider Identifier [NPI]: | 1063604338 |
| Last Name Of The Provider | BELSOM |
| First Name Of The Provider | REBECCA |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7373 PERKINS RD |
| Street Address 2 Of The Provider | ATTN: CAMILLE/ ADMINISTRATION |
| City Of The Provider | BATON ROUGE |
| Zip Code Of The Provider | 708084326 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Rheumatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 83 |
| Number Of Services | 4643 |
| Number Of Medicare Beneficiaries | 270 |
| Total Submitted Charge Amount | 209609 |
| Total Medicare Allowed Amount | 103136.7 |
| Total Medicare Payment Amount | 80470.58 |
| Total Medicare Standardized Payment Amount | 80449.85 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 9 |
| Number Of Drug Services | 2029 |
| Number Of Medicare Beneficiaries With Drug Services | 72 |
| Total Drug Submitted ChargeAmount | 30148 |
| Total Drug Medicare AllowedAmount | 14757.76 |
| Total Drug Medicare PaymentAmount | 11588.93 |
| Total Drug Medicare Standardized Payment Amount | 11588.93 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 74 |
| Number Of Medical Services | 2614 |
| Number Of Medicare Beneficiaries With Medical Services | 270 |
| Total Medical Submitted Charge Amount | 179461 |
| Total Medical Medicare Allowed Amount | 88378.94 |
| Total Medical Medicare Payment Amount | 68881.65 |
| Total Medical Medicare Standardized Payment Amount | 68860.92 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 49 |
| Number Of Beneficiaries Age 65 to 74 | 117 |
| Number Of Beneficiaries Age 75 to 84 | 70 |
| Number Of Beneficiaries Age Greater 84 | 34 |
| Number Of Female Beneficiaries | 201 |
| Number Of Male Beneficiaries | 69 |
| Number Of Non Hispanic White Beneficiaries | 182 |
| 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 | 210 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 60 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 20 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 34 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 65 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2913 |