| National Provider Identifier [NPI]: | 1407839806 |
| Last Name Of The Provider | GRISALES |
| First Name Of The Provider | DARIO |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 16542 N DALE MABRY HWY |
| Street Address 2 Of The Provider | |
| City Of The Provider | TAMPA |
| Zip Code Of The Provider | 336181325 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 54 |
| Number Of Services | 5475 |
| Number Of Medicare Beneficiaries | 159 |
| Total Submitted Charge Amount | 373693.58 |
| Total Medicare Allowed Amount | 150305.92 |
| Total Medicare Payment Amount | 107593.84 |
| Total Medicare Standardized Payment Amount | 111345.38 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 4096 |
| Number Of Medicare Beneficiaries With Drug Services | 45 |
| Total Drug Submitted ChargeAmount | 63121.61 |
| Total Drug Medicare AllowedAmount | 27488.65 |
| Total Drug Medicare PaymentAmount | 21011.85 |
| Total Drug Medicare Standardized Payment Amount | 21011.85 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 48 |
| Number Of Medical Services | 1379 |
| Number Of Medicare Beneficiaries With Medical Services | 159 |
| Total Medical Submitted Charge Amount | 310571.97 |
| Total Medical Medicare Allowed Amount | 122817.27 |
| Total Medical Medicare Payment Amount | 86581.99 |
| Total Medical Medicare Standardized Payment Amount | 90333.53 |
| Average Age Of Beneficiaries | 60 |
| Number Of Beneficiaries Age Less65 | 101 |
| Number Of Beneficiaries Age 65 to 74 | 35 |
| Number Of Beneficiaries Age 75 to 84 | |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 105 |
| Number Of Male Beneficiaries | 54 |
| Number Of Non Hispanic White Beneficiaries | 104 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 34 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 90 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 69 |
| Percent Of With Atrial Fibrillation | 8 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 22 |
| Percent Of With Cancer | |
| Percent Of With Heart Failure | 27 |
| Percent Of With Chronic Kidney Disease | 26 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 47 |
| Percent Of With Diabetes | 39 |
| Percent Of With Hyperlipidemia | 58 |
| Percent Of With Hypertension | 72 |
| Percent Of With Ischemic Heart Disease | 48 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 2.2237 |