| National Provider Identifier [NPI]: | 1245241348 |
| Last Name Of The Provider | BANKS |
| First Name Of The Provider | SANDRA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7503 SURRATTS RD |
| Street Address 2 Of The Provider | SUITE G125 |
| City Of The Provider | CLINTON |
| Zip Code Of The Provider | 207353358 |
| State Code Of The Provider | MD |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 10 |
| Number Of Services | 672 |
| Number Of Medicare Beneficiaries | 597 |
| Total Submitted Charge Amount | 491237 |
| Total Medicare Allowed Amount | 123705.19 |
| Total Medicare Payment Amount | 92805.74 |
| Total Medicare Standardized Payment Amount | 85355.57 |
| 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 | 10 |
| Number Of Medical Services | 672 |
| Number Of Medicare Beneficiaries With Medical Services | 597 |
| Total Medical Submitted Charge Amount | 491237 |
| Total Medical Medicare Allowed Amount | 123705.19 |
| Total Medical Medicare Payment Amount | 92805.74 |
| Total Medical Medicare Standardized Payment Amount | 85355.57 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 162 |
| Number Of Beneficiaries Age 65 to 74 | 207 |
| Number Of Beneficiaries Age 75 to 84 | 136 |
| Number Of Beneficiaries Age Greater 84 | 92 |
| Number Of Female Beneficiaries | 350 |
| Number Of Male Beneficiaries | 247 |
| Number Of Non Hispanic White Beneficiaries | 99 |
| Number Of Black or African American Beneficiaries | 480 |
| 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 | 396 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 201 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 43 |
| Percent Of With Chronic Kidney Disease | 53 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 25 |
| Percent Of With Depression | 23 |
| Percent Of With Diabetes | 60 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 55 |
| Percent Of With Osteoporosis | 5 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 11 |
| Percent Of With Stroke | 16 |
| Average HCC Risk Score Of Beneficiaries | 2.5106 |