| National Provider Identifier [NPI]: | 1780830703 |
| Last Name Of The Provider | BOULOS |
| First Name Of The Provider | DANY |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 11000 ROOSEVELT BLVD |
| Street Address 2 Of The Provider | 360 |
| City Of The Provider | PHILADELPHIA |
| Zip Code Of The Provider | 191163961 |
| State Code Of The Provider | PA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 47 |
| Number Of Services | 950 |
| Number Of Medicare Beneficiaries | 299 |
| Total Submitted Charge Amount | 90966 |
| Total Medicare Allowed Amount | 62318.32 |
| Total Medicare Payment Amount | 43575.9 |
| Total Medicare Standardized Payment Amount | 46556 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 7 |
| Number Of Drug Services | 125 |
| Number Of Medicare Beneficiaries With Drug Services | 42 |
| Total Drug Submitted ChargeAmount | 3082 |
| Total Drug Medicare AllowedAmount | 1374.58 |
| Total Drug Medicare PaymentAmount | 1322 |
| Total Drug Medicare Standardized Payment Amount | 1322 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 40 |
| Number Of Medical Services | 825 |
| Number Of Medicare Beneficiaries With Medical Services | 299 |
| Total Medical Submitted Charge Amount | 87884 |
| Total Medical Medicare Allowed Amount | 60943.74 |
| Total Medical Medicare Payment Amount | 42253.9 |
| Total Medical Medicare Standardized Payment Amount | 45234 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 84 |
| Number Of Beneficiaries Age 65 to 74 | 111 |
| Number Of Beneficiaries Age 75 to 84 | 73 |
| Number Of Beneficiaries Age Greater 84 | 31 |
| Number Of Female Beneficiaries | 159 |
| Number Of Male Beneficiaries | 140 |
| Number Of Non Hispanic White Beneficiaries | 287 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 194 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 105 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 32 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 44 |
| Percent Of With Hypertension | 64 |
| Percent Of With Ischemic Heart Disease | 50 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 36 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 10 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2925 |