| National Provider Identifier [NPI]: | 1891852521 |
| Last Name Of The Provider | SANSOM |
| First Name Of The Provider | ROBERT |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4351 MCCANN ROAD |
| Street Address 2 Of The Provider | |
| City Of The Provider | LONGVIEW |
| Zip Code Of The Provider | 75605 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 7 |
| Number Of Services | 245 |
| Number Of Medicare Beneficiaries | 103 |
| Total Submitted Charge Amount | 49286 |
| Total Medicare Allowed Amount | 22367.77 |
| Total Medicare Payment Amount | 17536.15 |
| Total Medicare Standardized Payment Amount | 19048.52 |
| 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 | 7 |
| Number Of Medical Services | 245 |
| Number Of Medicare Beneficiaries With Medical Services | 103 |
| Total Medical Submitted Charge Amount | 49286 |
| Total Medical Medicare Allowed Amount | 22367.77 |
| Total Medical Medicare Payment Amount | 17536.15 |
| Total Medical Medicare Standardized Payment Amount | 19048.52 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 28 |
| Number Of Beneficiaries Age 65 to 74 | 24 |
| Number Of Beneficiaries Age 75 to 84 | 32 |
| Number Of Beneficiaries Age Greater 84 | 19 |
| Number Of Female Beneficiaries | 54 |
| Number Of Male Beneficiaries | 49 |
| Number Of Non Hispanic White Beneficiaries | 70 |
| 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 | 58 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 45 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 35 |
| Percent Of With Asthma | 12 |
| Percent Of With Cancer | 21 |
| Percent Of With Heart Failure | 61 |
| Percent Of With Chronic Kidney Disease | 74 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 54 |
| Percent Of With Depression | 34 |
| Percent Of With Diabetes | 45 |
| Percent Of With Hyperlipidemia | 42 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 51 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 2.9815 |