| National Provider Identifier [NPI]: | 1215924154 |
| Last Name Of The Provider | DAITCH |
| First Name Of The Provider | JONATHAN |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 8255 COLLEGE PKWY |
| Street Address 2 Of The Provider | STE 100 |
| City Of The Provider | FORT MYERS |
| Zip Code Of The Provider | 339195119 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 105 |
| Number Of Services | 67688 |
| Number Of Medicare Beneficiaries | 1284 |
| Total Submitted Charge Amount | 8056642.95 |
| Total Medicare Allowed Amount | 2503884.01 |
| Total Medicare Payment Amount | 2104205.5 |
| Total Medicare Standardized Payment Amount | 1847168.31 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 16 |
| Number Of Drug Services | 24656 |
| Number Of Medicare Beneficiaries With Drug Services | 484 |
| Total Drug Submitted ChargeAmount | 449473.95 |
| Total Drug Medicare AllowedAmount | 150469.71 |
| Total Drug Medicare PaymentAmount | 117823.95 |
| Total Drug Medicare Standardized Payment Amount | 117823.95 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 89 |
| Number Of Medical Services | 43032 |
| Number Of Medicare Beneficiaries With Medical Services | 1284 |
| Total Medical Submitted Charge Amount | 7607169 |
| Total Medical Medicare Allowed Amount | 2353414.3 |
| Total Medical Medicare Payment Amount | 1986381.55 |
| Total Medical Medicare Standardized Payment Amount | 1729344.36 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 391 |
| Number Of Beneficiaries Age 65 to 74 | 443 |
| Number Of Beneficiaries Age 75 to 84 | 306 |
| Number Of Beneficiaries Age Greater 84 | 144 |
| Number Of Female Beneficiaries | 759 |
| Number Of Male Beneficiaries | 525 |
| Number Of Non Hispanic White Beneficiaries | 1167 |
| Number Of Black or African American Beneficiaries | 34 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 64 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 999 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 285 |
| Percent Of With Atrial Fibrillation | 10 |
| Percent Of With Alzheimers Disease or Dementia | 8 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 10 |
| Percent Of With Heart Failure | 17 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 31 |
| Percent Of With Hyperlipidemia | 59 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 40 |
| Percent Of With Osteoporosis | 13 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 6 |
| Average HCC Risk Score Of Beneficiaries | 1.4193 |