| National Provider Identifier [NPI]: | 1912972530 |
| Last Name Of The Provider | MATRICIA |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | J |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 96279 BRADY POINT RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | FERNANDINA BEACH |
| Zip Code Of The Provider | 320347076 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 96 |
| Number Of Services | 3339 |
| Number Of Medicare Beneficiaries | 1312 |
| Total Submitted Charge Amount | 402479 |
| Total Medicare Allowed Amount | 205661.87 |
| Total Medicare Payment Amount | 136884.08 |
| Total Medicare Standardized Payment Amount | 137171.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 23 |
| Number Of Drug Services | 828 |
| Number Of Medicare Beneficiaries With Drug Services | 281 |
| Total Drug Submitted ChargeAmount | 22199 |
| Total Drug Medicare AllowedAmount | 2898.75 |
| Total Drug Medicare PaymentAmount | 2404.25 |
| Total Drug Medicare Standardized Payment Amount | 2404.25 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 73 |
| Number Of Medical Services | 2511 |
| Number Of Medicare Beneficiaries With Medical Services | 1312 |
| Total Medical Submitted Charge Amount | 380280 |
| Total Medical Medicare Allowed Amount | 202763.12 |
| Total Medical Medicare Payment Amount | 134479.83 |
| Total Medical Medicare Standardized Payment Amount | 134767.13 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 108 |
| Number Of Beneficiaries Age 65 to 74 | 744 |
| Number Of Beneficiaries Age 75 to 84 | 354 |
| Number Of Beneficiaries Age Greater 84 | 106 |
| Number Of Female Beneficiaries | 829 |
| Number Of Male Beneficiaries | 483 |
| Number Of Non Hispanic White Beneficiaries | 1217 |
| Number Of Black or African American Beneficiaries | 55 |
| 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 | 1243 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 69 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 13 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 15 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 60 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 1 |
| Percent Of With Stroke | 3 |
| Average HCC Risk Score Of Beneficiaries | 0.8748 |