| National Provider Identifier [NPI]: | 1326083148 |
| Last Name Of The Provider | DASSOPOULOS |
| First Name Of The Provider | THEMISTOCLES |
| 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 | 4921 PARKVIEW PL |
| Street Address 2 Of The Provider | STE 8C |
| City Of The Provider | SAINT LOUIS |
| Zip Code Of The Provider | 631101032 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Gastroenterology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 659 |
| Number Of Medicare Beneficiaries | 247 |
| Total Submitted Charge Amount | 201946.5 |
| Total Medicare Allowed Amount | 51129.85 |
| Total Medicare Payment Amount | 37868.6 |
| Total Medicare Standardized Payment Amount | 38982.58 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 295 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 10236.5 |
| Total Drug Medicare AllowedAmount | 4757.62 |
| Total Drug Medicare PaymentAmount | 3755.8 |
| Total Drug Medicare Standardized Payment Amount | 3755.8 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 41 |
| Number Of Medical Services | 364 |
| Number Of Medicare Beneficiaries With Medical Services | 247 |
| Total Medical Submitted Charge Amount | 191710 |
| Total Medical Medicare Allowed Amount | 46372.23 |
| Total Medical Medicare Payment Amount | 34112.8 |
| Total Medical Medicare Standardized Payment Amount | 35226.78 |
| Average Age Of Beneficiaries | 62 |
| Number Of Beneficiaries Age Less65 | 120 |
| Number Of Beneficiaries Age 65 to 74 | 78 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 140 |
| Number Of Male Beneficiaries | 107 |
| Number Of Non Hispanic White Beneficiaries | 181 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 152 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 95 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 9 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 36 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 45 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 43 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 2.2121 |