| National Provider Identifier [NPI]: | 1962798843 |
| Last Name Of The Provider | SAMII |
| First Name Of The Provider | MARK |
| Middle Initial Of The Provider | S |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2750 ASTER ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | LAKE CHARLES |
| Zip Code Of The Provider | 706018824 |
| State Code Of The Provider | LA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 21 |
| Number Of Services | 153 |
| Number Of Medicare Beneficiaries | 72 |
| Total Submitted Charge Amount | 18998 |
| Total Medicare Allowed Amount | 7962.99 |
| Total Medicare Payment Amount | 6299.47 |
| Total Medicare Standardized Payment Amount | 6690.96 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 19 |
| Number Of Medicare Beneficiaries With Drug Services | 13 |
| Total Drug Submitted ChargeAmount | 617 |
| Total Drug Medicare AllowedAmount | 535.45 |
| Total Drug Medicare PaymentAmount | 523.71 |
| Total Drug Medicare Standardized Payment Amount | 523.71 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 134 |
| Number Of Medicare Beneficiaries With Medical Services | 72 |
| Total Medical Submitted Charge Amount | 18381 |
| Total Medical Medicare Allowed Amount | 7427.54 |
| Total Medical Medicare Payment Amount | 5775.76 |
| Total Medical Medicare Standardized Payment Amount | 6167.25 |
| Average Age Of Beneficiaries | 70 |
| Number Of Beneficiaries Age Less65 | 15 |
| Number Of Beneficiaries Age 65 to 74 | 28 |
| Number Of Beneficiaries Age 75 to 84 | 15 |
| Number Of Beneficiaries Age Greater 84 | 14 |
| Number Of Female Beneficiaries | 45 |
| Number Of Male Beneficiaries | 27 |
| Number Of Non Hispanic White Beneficiaries | 19 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 40 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 43 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 29 |
| 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 | 26 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 33 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 43 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 43 |
| Percent Of With Osteoporosis | |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 40 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.4609 |