| National Provider Identifier [NPI]: | 1215951710 |
| Last Name Of The Provider | DALL'OLMO |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | P |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 10850 E TRAVERSE HWY |
| Street Address 2 Of The Provider | SUITE 60 |
| City Of The Provider | TRAVERSE CITY |
| Zip Code Of The Provider | 496841364 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Radiology |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 208 |
| Number Of Services | 3191 |
| Number Of Medicare Beneficiaries | 2103 |
| Total Submitted Charge Amount | 525802 |
| Total Medicare Allowed Amount | 127980.57 |
| Total Medicare Payment Amount | 95211.11 |
| Total Medicare Standardized Payment Amount | 98067.69 |
| 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 | 208 |
| Number Of Medical Services | 3191 |
| Number Of Medicare Beneficiaries With Medical Services | 2103 |
| Total Medical Submitted Charge Amount | 525802 |
| Total Medical Medicare Allowed Amount | 127980.57 |
| Total Medical Medicare Payment Amount | 95211.11 |
| Total Medical Medicare Standardized Payment Amount | 98067.69 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 407 |
| Number Of Beneficiaries Age 65 to 74 | 712 |
| Number Of Beneficiaries Age 75 to 84 | 669 |
| Number Of Beneficiaries Age Greater 84 | 315 |
| Number Of Female Beneficiaries | 1130 |
| Number Of Male Beneficiaries | 973 |
| Number Of Non Hispanic White Beneficiaries | 2026 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 23 |
| Number Of American Indian Alaska Native Beneficiaries | 32 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 1519 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 584 |
| Percent Of With Atrial Fibrillation | 19 |
| Percent Of With Alzheimers Disease or Dementia | 14 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 17 |
| Percent Of With Heart Failure | 32 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 32 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 49 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 46 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 5 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.7391 |