| National Provider Identifier [NPI]: | 1174572986 |
| Last Name Of The Provider | BELISSARY |
| First Name Of The Provider | M |
| Middle Initial Of The Provider | N |
| Credentials Of The Provider | MD |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 3612 DALE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | MODESTO |
| Zip Code Of The Provider | 953560500 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 35 |
| Number Of Services | 1060 |
| Number Of Medicare Beneficiaries | 219 |
| Total Submitted Charge Amount | 195740.43 |
| Total Medicare Allowed Amount | 72879.55 |
| Total Medicare Payment Amount | 52667.54 |
| Total Medicare Standardized Payment Amount | 50815.22 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 11 |
| Number Of Drug Services | 289 |
| Number Of Medicare Beneficiaries With Drug Services | 54 |
| Total Drug Submitted ChargeAmount | 6739.43 |
| Total Drug Medicare AllowedAmount | 3010.99 |
| Total Drug Medicare PaymentAmount | 2862.06 |
| Total Drug Medicare Standardized Payment Amount | 2862.06 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 771 |
| Number Of Medicare Beneficiaries With Medical Services | 219 |
| Total Medical Submitted Charge Amount | 189001 |
| Total Medical Medicare Allowed Amount | 69868.56 |
| Total Medical Medicare Payment Amount | 49805.48 |
| Total Medical Medicare Standardized Payment Amount | 47953.16 |
| Average Age Of Beneficiaries | 68 |
| Number Of Beneficiaries Age Less65 | 54 |
| Number Of Beneficiaries Age 65 to 74 | 105 |
| Number Of Beneficiaries Age 75 to 84 | 37 |
| Number Of Beneficiaries Age Greater 84 | 23 |
| Number Of Female Beneficiaries | 170 |
| Number Of Male Beneficiaries | 49 |
| Number Of Non Hispanic White Beneficiaries | 159 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 44 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 156 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 63 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 6 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 7 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 28 |
| Percent Of With Diabetes | 24 |
| Percent Of With Hyperlipidemia | 41 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 21 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 37 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.0047 |