| National Provider Identifier [NPI]: | 1063404051 |
| Last Name Of The Provider | GRISAITIS |
| First Name Of The Provider | WILLIAM |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 331 N MAITLAND AVE |
| Street Address 2 Of The Provider | BUILDING A SUITE 5 |
| City Of The Provider | MAITLAND |
| Zip Code Of The Provider | 327514762 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Dermatology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 76 |
| Number Of Services | 7136 |
| Number Of Medicare Beneficiaries | 1437 |
| Total Submitted Charge Amount | 803752.83 |
| Total Medicare Allowed Amount | 699981.43 |
| Total Medicare Payment Amount | 521066.64 |
| Total Medicare Standardized Payment Amount | 520961.4 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 22 |
| Number Of Medicare Beneficiaries With Drug Services | 21 |
| Total Drug Submitted ChargeAmount | 4515.9 |
| Total Drug Medicare AllowedAmount | 4470.51 |
| Total Drug Medicare PaymentAmount | 3504.79 |
| Total Drug Medicare Standardized Payment Amount | 3504.79 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 74 |
| Number Of Medical Services | 7114 |
| Number Of Medicare Beneficiaries With Medical Services | 1437 |
| Total Medical Submitted Charge Amount | 799236.93 |
| Total Medical Medicare Allowed Amount | 695510.92 |
| Total Medical Medicare Payment Amount | 517561.85 |
| Total Medical Medicare Standardized Payment Amount | 517456.61 |
| Average Age Of Beneficiaries | 77 |
| Number Of Beneficiaries Age Less65 | 22 |
| Number Of Beneficiaries Age 65 to 74 | 603 |
| Number Of Beneficiaries Age 75 to 84 | 540 |
| Number Of Beneficiaries Age Greater 84 | 272 |
| Number Of Female Beneficiaries | 720 |
| Number Of Male Beneficiaries | 717 |
| Number Of Non Hispanic White Beneficiaries | 1402 |
| 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 | 19 |
| Number Of Beneficiaries With Medicare Only Entitlement | 1425 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 12 |
| Percent Of With Atrial Fibrillation | 15 |
| Percent Of With Alzheimers Disease or Dementia | 7 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 11 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 10 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 68 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 38 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 0.9725 |