| National Provider Identifier [NPI]: | 1972706596 |
| Last Name Of The Provider | PREMO |
| First Name Of The Provider | ALISON |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 2799 WEST GRAND BLD. |
| Street Address 2 Of The Provider | 4TH FLOOR |
| City Of The Provider | DETROIT |
| Zip Code Of The Provider | 48202 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Anesthesiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 83 |
| Number Of Services | 485 |
| Number Of Medicare Beneficiaries | 376 |
| Total Submitted Charge Amount | 486316 |
| Total Medicare Allowed Amount | 60676.15 |
| Total Medicare Payment Amount | 47310.87 |
| Total Medicare Standardized Payment Amount | 45098.38 |
| 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 | 83 |
| Number Of Medical Services | 485 |
| Number Of Medicare Beneficiaries With Medical Services | 376 |
| Total Medical Submitted Charge Amount | 486316 |
| Total Medical Medicare Allowed Amount | 60676.15 |
| Total Medical Medicare Payment Amount | 47310.87 |
| Total Medical Medicare Standardized Payment Amount | 45098.38 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 108 |
| Number Of Beneficiaries Age 65 to 74 | 146 |
| Number Of Beneficiaries Age 75 to 84 | 80 |
| Number Of Beneficiaries Age Greater 84 | 42 |
| Number Of Female Beneficiaries | 202 |
| Number Of Male Beneficiaries | 174 |
| Number Of Non Hispanic White Beneficiaries | 272 |
| Number Of Black or African American Beneficiaries | 68 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 19 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 247 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 129 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 19 |
| Percent Of With Asthma | 18 |
| Percent Of With Cancer | 16 |
| Percent Of With Heart Failure | 49 |
| Percent Of With Chronic Kidney Disease | 50 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 47 |
| Percent Of With Depression | 38 |
| Percent Of With Diabetes | 56 |
| Percent Of With Hyperlipidemia | 69 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 67 |
| Percent Of With Osteoporosis | 12 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 56 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 2.2481 |