| National Provider Identifier [NPI]: | 1356351811 |
| Last Name Of The Provider | OBRIEN |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | K |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2901 OLD JACKSONVILLE RD |
| Street Address 2 Of The Provider | |
| City Of The Provider | SPRINGFIELD |
| Zip Code Of The Provider | 627047437 |
| State Code Of The Provider | IL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 75 |
| Number Of Services | 2679 |
| Number Of Medicare Beneficiaries | 271 |
| Total Submitted Charge Amount | 139353 |
| Total Medicare Allowed Amount | 63622.89 |
| Total Medicare Payment Amount | 48803.16 |
| Total Medicare Standardized Payment Amount | 50348.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 8 |
| Number Of Drug Services | 79 |
| Number Of Medicare Beneficiaries With Drug Services | 54 |
| Total Drug Submitted ChargeAmount | 2700 |
| Total Drug Medicare AllowedAmount | 1098.89 |
| Total Drug Medicare PaymentAmount | 1032.27 |
| Total Drug Medicare Standardized Payment Amount | 1032.27 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 67 |
| Number Of Medical Services | 2600 |
| Number Of Medicare Beneficiaries With Medical Services | 271 |
| Total Medical Submitted Charge Amount | 136653 |
| Total Medical Medicare Allowed Amount | 62524 |
| Total Medical Medicare Payment Amount | 47770.89 |
| Total Medical Medicare Standardized Payment Amount | 49316.11 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 57 |
| Number Of Beneficiaries Age 65 to 74 | 88 |
| Number Of Beneficiaries Age 75 to 84 | 79 |
| Number Of Beneficiaries Age Greater 84 | 47 |
| Number Of Female Beneficiaries | 142 |
| Number Of Male Beneficiaries | 129 |
| Number Of Non Hispanic White Beneficiaries | 249 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 214 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 57 |
| Percent Of With Atrial Fibrillation | 7 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 18 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 18 |
| Percent Of With Depression | 30 |
| Percent Of With Diabetes | 35 |
| Percent Of With Hyperlipidemia | 51 |
| Percent Of With Hypertension | 70 |
| Percent Of With Ischemic Heart Disease | 32 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 34 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 4 |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.1408 |