| National Provider Identifier [NPI]: | 1811938509 |
| Last Name Of The Provider | DONNELLY |
| First Name Of The Provider | SANDRA |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 9080 COLIMA RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | WHITTIER |
| Zip Code Of The Provider | 906051600 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 28 |
| Number Of Services | 594 |
| Number Of Medicare Beneficiaries | 510 |
| Total Submitted Charge Amount | 318609 |
| Total Medicare Allowed Amount | 90035.9 |
| Total Medicare Payment Amount | 66832.7 |
| Total Medicare Standardized Payment Amount | 63858.24 |
| 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 | 28 |
| Number Of Medical Services | 594 |
| Number Of Medicare Beneficiaries With Medical Services | 510 |
| Total Medical Submitted Charge Amount | 318609 |
| Total Medical Medicare Allowed Amount | 90035.9 |
| Total Medical Medicare Payment Amount | 66832.7 |
| Total Medical Medicare Standardized Payment Amount | 63858.24 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 158 |
| Number Of Beneficiaries Age 65 to 74 | 144 |
| Number Of Beneficiaries Age 75 to 84 | 114 |
| Number Of Beneficiaries Age Greater 84 | 94 |
| Number Of Female Beneficiaries | 256 |
| Number Of Male Beneficiaries | 254 |
| Number Of Non Hispanic White Beneficiaries | 191 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 76 |
| Number Of Hispanic Beneficiaries | 178 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 73 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 437 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 46 |
| Percent Of With Asthma | 16 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 50 |
| Percent Of With Chronic Kidney Disease | 57 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 48 |
| Percent Of With Depression | 48 |
| Percent Of With Diabetes | 60 |
| Percent Of With Hyperlipidemia | 57 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 63 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 47 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 43 |
| Percent Of With Stroke | 17 |
| Average HCC Risk Score Of Beneficiaries | 3.291 |