| National Provider Identifier [NPI]: | 1831117449 |
| Last Name Of The Provider | GRISSOM |
| First Name Of The Provider | MARTIN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD, MS, FCCP |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2330 TIME CENTRE DR |
| Street Address 2 Of The Provider | |
| City Of The Provider | SAINT CHARLES |
| Zip Code Of The Provider | 633032112 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Anesthesiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 24 |
| Number Of Services | 404 |
| Number Of Medicare Beneficiaries | 154 |
| Total Submitted Charge Amount | 68490.8 |
| Total Medicare Allowed Amount | 34418.97 |
| Total Medicare Payment Amount | 26117.2 |
| Total Medicare Standardized Payment Amount | 26803.28 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 0 |
| Number Of Drug Services | 0 |
| Number Of Medicare Beneficiaries With Drug Services | 0 |
| Total Drug Submitted ChargeAmount | 0 |
| Total Drug Medicare AllowedAmount | 0 |
| Total Drug Medicare PaymentAmount | 0 |
| Total Drug Medicare Standardized Payment Amount | 0 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 24 |
| Number Of Medical Services | 404 |
| Number Of Medicare Beneficiaries With Medical Services | 154 |
| Total Medical Submitted Charge Amount | 68490.8 |
| Total Medical Medicare Allowed Amount | 34418.97 |
| Total Medical Medicare Payment Amount | 26117.2 |
| Total Medical Medicare Standardized Payment Amount | 26803.28 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 30 |
| Number Of Beneficiaries Age 65 to 74 | 43 |
| Number Of Beneficiaries Age 75 to 84 | 43 |
| Number Of Beneficiaries Age Greater 84 | 38 |
| Number Of Female Beneficiaries | 90 |
| Number Of Male Beneficiaries | 64 |
| Number Of Non Hispanic White Beneficiaries | 143 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 0 |
| Number Of Beneficiaries With Medicare Only Entitlement | 106 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 48 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 29 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 36 |
| Percent Of With Chronic Kidney Disease | 49 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 63 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 53 |
| Percent Of With Osteoporosis | 18 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 42 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 1.7881 |