| National Provider Identifier [NPI]: | 1679746622 |
| Last Name Of The Provider | HASELOW |
| First Name Of The Provider | DIRK |
| Middle Initial Of The Provider | T |
| Credentials Of The Provider | MD, PHD, MS |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 4815 W. MARKHAM STREET, MAILSLOT 48 |
| Street Address 2 Of The Provider | |
| City Of The Provider | LITTLE ROCK |
| Zip Code Of The Provider | 72205 |
| State Code Of The Provider | AR |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Pediatric Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 7 |
| Number Of Services | 11882 |
| Number Of Medicare Beneficiaries | 5943 |
| Total Submitted Charge Amount | 309647.58 |
| Total Medicare Allowed Amount | 237504.22 |
| Total Medicare Payment Amount | 232721.34 |
| Total Medicare Standardized Payment Amount | 242409.85 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 4 |
| Number Of Drug Services | 5940 |
| Number Of Medicare Beneficiaries With Drug Services | 5790 |
| Total Drug Submitted ChargeAmount | 104429.75 |
| Total Drug Medicare AllowedAmount | 104414.94 |
| Total Drug Medicare PaymentAmount | 102316.65 |
| Total Drug Medicare Standardized Payment Amount | 102316.65 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 3 |
| Number Of Medical Services | 5942 |
| Number Of Medicare Beneficiaries With Medical Services | 5941 |
| Total Medical Submitted Charge Amount | 205217.83 |
| Total Medical Medicare Allowed Amount | 133089.28 |
| Total Medical Medicare Payment Amount | 130404.69 |
| Total Medical Medicare Standardized Payment Amount | 140093.2 |
| Average Age Of Beneficiaries | 71 |
| Number Of Beneficiaries Age Less65 | 859 |
| Number Of Beneficiaries Age 65 to 74 | 3186 |
| Number Of Beneficiaries Age 75 to 84 | 1473 |
| Number Of Beneficiaries Age Greater 84 | 425 |
| Number Of Female Beneficiaries | 3253 |
| Number Of Male Beneficiaries | 2690 |
| Number Of Non Hispanic White Beneficiaries | 5240 |
| Number Of Black or African American Beneficiaries | 603 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 35 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | 45 |
| Number Of Beneficiaries With Medicare Only Entitlement | 5085 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 858 |
| Percent Of With Atrial Fibrillation | 5 |
| Percent Of With Alzheimers Disease or Dementia | 5 |
| Percent Of With Asthma | 3 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 10 |
| Percent Of With Chronic Kidney Disease | 8 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 7 |
| Percent Of With Depression | 10 |
| Percent Of With Diabetes | 22 |
| Percent Of With Hyperlipidemia | 35 |
| Percent Of With Hypertension | 51 |
| Percent Of With Ischemic Heart Disease | 28 |
| Percent Of With Osteoporosis | 4 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 23 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 2 |
| Average HCC Risk Score Of Beneficiaries | 0.7562 |