| National Provider Identifier [NPI]: | 1245205228 |
| Last Name Of The Provider | BLACK |
| First Name Of The Provider | DAVID |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 625 9TH AVE |
| Street Address 2 Of The Provider | STE 210 |
| City Of The Provider | LONGVIEW |
| Zip Code Of The Provider | 986322465 |
| State Code Of The Provider | WA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Orthopedic Surgery |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 46 |
| Number Of Services | 257 |
| Number Of Medicare Beneficiaries | 62 |
| Total Submitted Charge Amount | 67905.5 |
| Total Medicare Allowed Amount | 26708.4 |
| Total Medicare Payment Amount | 19440.13 |
| Total Medicare Standardized Payment Amount | 20158.95 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 71 |
| Number Of Medicare Beneficiaries With Drug Services | 17 |
| Total Drug Submitted ChargeAmount | 248.5 |
| Total Drug Medicare AllowedAmount | 210.36 |
| Total Drug Medicare PaymentAmount | 154.92 |
| Total Drug Medicare Standardized Payment Amount | 154.92 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 44 |
| Number Of Medical Services | 186 |
| Number Of Medicare Beneficiaries With Medical Services | 62 |
| Total Medical Submitted Charge Amount | 67657 |
| Total Medical Medicare Allowed Amount | 26498.04 |
| Total Medical Medicare Payment Amount | 19285.21 |
| Total Medical Medicare Standardized Payment Amount | 20004.03 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 24 |
| Number Of Beneficiaries Age 75 to 84 | 20 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 35 |
| Number Of Male Beneficiaries | 27 |
| Number Of Non Hispanic White Beneficiaries | 62 |
| Number Of Black or African American Beneficiaries | 0 |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | 0 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 45 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 31 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 26 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 56 |
| Percent Of With Ischemic Heart Disease | 31 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.2138 |