| National Provider Identifier [NPI]: | 1669507505 |
| Last Name Of The Provider | DAISLEY |
| First Name Of The Provider | SAMUEL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 149 E MAIN ST |
| Street Address 2 Of The Provider | BOX 1117 |
| City Of The Provider | ANDOVER |
| Zip Code Of The Provider | 440039479 |
| State Code Of The Provider | OH |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 79 |
| Number Of Services | 5176 |
| Number Of Medicare Beneficiaries | 597 |
| Total Submitted Charge Amount | 391561 |
| Total Medicare Allowed Amount | 229206.71 |
| Total Medicare Payment Amount | 168734.7 |
| Total Medicare Standardized Payment Amount | 176040.73 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 487 |
| Number Of Medicare Beneficiaries With Drug Services | 237 |
| Total Drug Submitted ChargeAmount | 16527 |
| Total Drug Medicare AllowedAmount | 10165.58 |
| Total Drug Medicare PaymentAmount | 9676.89 |
| Total Drug Medicare Standardized Payment Amount | 9676.89 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 68 |
| Number Of Medical Services | 4689 |
| Number Of Medicare Beneficiaries With Medical Services | 597 |
| Total Medical Submitted Charge Amount | 375034 |
| Total Medical Medicare Allowed Amount | 219041.13 |
| Total Medical Medicare Payment Amount | 159057.81 |
| Total Medical Medicare Standardized Payment Amount | 166363.84 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 137 |
| Number Of Beneficiaries Age 65 to 74 | 222 |
| Number Of Beneficiaries Age 75 to 84 | 175 |
| Number Of Beneficiaries Age Greater 84 | 63 |
| Number Of Female Beneficiaries | 329 |
| Number Of Male Beneficiaries | 268 |
| Number Of Non Hispanic White Beneficiaries | 580 |
| Number Of Black or African American Beneficiaries | |
| 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 | 468 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 129 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 4 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 13 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 55 |
| Percent Of With Hypertension | 66 |
| Percent Of With Ischemic Heart Disease | 35 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 3 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 1.158 |