| National Provider Identifier [NPI]: | 1871686337 |
| Last Name Of The Provider | DACK |
| First Name Of The Provider | MARTY |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | NP |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1703 E MICHIGAN AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | LANSING |
| Zip Code Of The Provider | 489122841 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 37 |
| Number Of Services | 38706 |
| Number Of Medicare Beneficiaries | 399 |
| Total Submitted Charge Amount | 302858 |
| Total Medicare Allowed Amount | 165337.57 |
| Total Medicare Payment Amount | 125496.69 |
| Total Medicare Standardized Payment Amount | 141017.61 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 36830 |
| Number Of Medicare Beneficiaries With Drug Services | 66 |
| Total Drug Submitted ChargeAmount | 148303 |
| Total Drug Medicare AllowedAmount | 76053.11 |
| Total Drug Medicare PaymentAmount | 59530.1 |
| Total Drug Medicare Standardized Payment Amount | 59530.1 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 29 |
| Number Of Medical Services | 1876 |
| Number Of Medicare Beneficiaries With Medical Services | 399 |
| Total Medical Submitted Charge Amount | 154555 |
| Total Medical Medicare Allowed Amount | 89284.46 |
| Total Medical Medicare Payment Amount | 65966.59 |
| Total Medical Medicare Standardized Payment Amount | 81487.51 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 78 |
| Number Of Beneficiaries Age 65 to 74 | 142 |
| Number Of Beneficiaries Age 75 to 84 | 101 |
| Number Of Beneficiaries Age Greater 84 | 78 |
| Number Of Female Beneficiaries | 214 |
| Number Of Male Beneficiaries | 185 |
| Number Of Non Hispanic White Beneficiaries | 339 |
| Number Of Black or African American Beneficiaries | 41 |
| 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 | 294 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 105 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 12 |
| Percent Of With Asthma | 11 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 39 |
| Percent Of With Chronic Kidney Disease | 75 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 27 |
| Percent Of With Diabetes | 54 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | 4 |
| Average HCC Risk Score Of Beneficiaries | 2.1178 |