| National Provider Identifier [NPI]: | 1609824648 |
| Last Name Of The Provider | DAUPHIN |
| First Name Of The Provider | SERGE |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 600 ROE AVENUE |
| Street Address 2 Of The Provider | |
| City Of The Provider | ELMIRA |
| Zip Code Of The Provider | 14905 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Hematology/Oncology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 84 |
| Number Of Services | 120072 |
| Number Of Medicare Beneficiaries | 582 |
| Total Submitted Charge Amount | 4051484.95 |
| Total Medicare Allowed Amount | 1980929.62 |
| Total Medicare Payment Amount | 1546665.63 |
| Total Medicare Standardized Payment Amount | 1551696.32 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 50 |
| Number Of Drug Services | 111890 |
| Number Of Medicare Beneficiaries With Drug Services | 95 |
| Total Drug Submitted ChargeAmount | 3293018.95 |
| Total Drug Medicare AllowedAmount | 1637236 |
| Total Drug Medicare PaymentAmount | 1281418.85 |
| Total Drug Medicare Standardized Payment Amount | 1281418.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 34 |
| Number Of Medical Services | 8182 |
| Number Of Medicare Beneficiaries With Medical Services | 582 |
| Total Medical Submitted Charge Amount | 758466 |
| Total Medical Medicare Allowed Amount | 343693.62 |
| Total Medical Medicare Payment Amount | 265246.78 |
| Total Medical Medicare Standardized Payment Amount | 270277.47 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 123 |
| Number Of Beneficiaries Age 65 to 74 | 195 |
| Number Of Beneficiaries Age 75 to 84 | 173 |
| Number Of Beneficiaries Age Greater 84 | 91 |
| Number Of Female Beneficiaries | 338 |
| Number Of Male Beneficiaries | 244 |
| Number Of Non Hispanic White Beneficiaries | 550 |
| Number Of Black or African American Beneficiaries | 17 |
| 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 | 420 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 162 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 35 |
| Percent Of With Heart Failure | 26 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 24 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 53 |
| Percent Of With Hypertension | 69 |
| Percent Of With Ischemic Heart Disease | 38 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.9121 |