| National Provider Identifier [NPI]: | 1659338630 |
| Last Name Of The Provider | SALLACH |
| First Name Of The Provider | SUSAN |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 301 W WACKERLY ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | MIDLAND |
| Zip Code Of The Provider | 486402761 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Cardiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 48 |
| Number Of Services | 5270 |
| Number Of Medicare Beneficiaries | 2752 |
| Total Submitted Charge Amount | 619013 |
| Total Medicare Allowed Amount | 220023.63 |
| Total Medicare Payment Amount | 167011.45 |
| Total Medicare Standardized Payment Amount | 171775.16 |
| Drug Suppress Indicator | * |
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| Medical SuppressIndicator | # |
| Number Of HCPCS Associated With MedicalServices | |
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| Number Of Medicare Beneficiaries With Medical Services | |
| Total Medical Submitted Charge Amount | |
| Total Medical Medicare Allowed Amount | |
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| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 409 |
| Number Of Beneficiaries Age 65 to 74 | 1006 |
| Number Of Beneficiaries Age 75 to 84 | 869 |
| Number Of Beneficiaries Age Greater 84 | 468 |
| Number Of Female Beneficiaries | 1394 |
| Number Of Male Beneficiaries | 1358 |
| Number Of Non Hispanic White Beneficiaries | 2664 |
| Number Of Black or African American Beneficiaries | 26 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 20 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 24 |
| Number Of Beneficiaries With Medicare Only Entitlement | 2167 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 585 |
| Percent Of With Atrial Fibrillation | 31 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 14 |
| Percent Of With Heart Failure | 45 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 72 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 69 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 44 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 6 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.6675 |