| National Provider Identifier [NPI]: | 1598718314 |
| Last Name Of The Provider | NELSON |
| First Name Of The Provider | DALLAS |
| Middle Initial Of The Provider | L |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1000 SOUTH AVE |
| Street Address 2 Of The Provider | BOX 58 |
| City Of The Provider | ROCHESTER |
| Zip Code Of The Provider | 146202733 |
| State Code Of The Provider | NY |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Geriatric Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 19 |
| Number Of Services | 587 |
| Number Of Medicare Beneficiaries | 186 |
| Total Submitted Charge Amount | 92811 |
| Total Medicare Allowed Amount | 42750.77 |
| Total Medicare Payment Amount | 31137.53 |
| Total Medicare Standardized Payment Amount | 33417.53 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 2 |
| Number Of Drug Services | 77 |
| Number Of Medicare Beneficiaries With Drug Services | 77 |
| Total Drug Submitted ChargeAmount | 1205 |
| Total Drug Medicare AllowedAmount | 1173.4 |
| Total Drug Medicare PaymentAmount | 1149.9 |
| Total Drug Medicare Standardized Payment Amount | 1149.9 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 17 |
| Number Of Medical Services | 510 |
| Number Of Medicare Beneficiaries With Medical Services | 186 |
| Total Medical Submitted Charge Amount | 91606 |
| Total Medical Medicare Allowed Amount | 41577.37 |
| Total Medical Medicare Payment Amount | 29987.63 |
| Total Medical Medicare Standardized Payment Amount | 32267.63 |
| Average Age Of Beneficiaries | 85 |
| Number Of Beneficiaries Age Less65 | 11 |
| Number Of Beneficiaries Age 65 to 74 | 14 |
| Number Of Beneficiaries Age 75 to 84 | 37 |
| Number Of Beneficiaries Age Greater 84 | 124 |
| Number Of Female Beneficiaries | 136 |
| Number Of Male Beneficiaries | 50 |
| Number Of Non Hispanic White Beneficiaries | 174 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 122 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 64 |
| Percent Of With Atrial Fibrillation | 17 |
| Percent Of With Alzheimers Disease or Dementia | 53 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 29 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 12 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 25 |
| Percent Of With Hyperlipidemia | 34 |
| Percent Of With Hypertension | 59 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 15 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 8 |
| Average HCC Risk Score Of Beneficiaries | 1.9228 |