| National Provider Identifier [NPI]: | 1316177066 |
| Last Name Of The Provider | GRANT |
| First Name Of The Provider | MERKEZA |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | D.O. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 6300 LA CALMA DR STE 200 |
| Street Address 2 Of The Provider | |
| City Of The Provider | AUSTIN |
| Zip Code Of The Provider | 787523825 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 27 |
| Number Of Services | 720 |
| Number Of Medicare Beneficiaries | 335 |
| Total Submitted Charge Amount | 357570 |
| Total Medicare Allowed Amount | 63885.38 |
| Total Medicare Payment Amount | 48906.58 |
| Total Medicare Standardized Payment Amount | 50384.66 |
| 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 | 27 |
| Number Of Medical Services | 720 |
| Number Of Medicare Beneficiaries With Medical Services | 335 |
| Total Medical Submitted Charge Amount | 357570 |
| Total Medical Medicare Allowed Amount | 63885.38 |
| Total Medical Medicare Payment Amount | 48906.58 |
| Total Medical Medicare Standardized Payment Amount | 50384.66 |
| Average Age Of Beneficiaries | 64 |
| Number Of Beneficiaries Age Less65 | 135 |
| Number Of Beneficiaries Age 65 to 74 | 112 |
| Number Of Beneficiaries Age 75 to 84 | 51 |
| Number Of Beneficiaries Age Greater 84 | 37 |
| Number Of Female Beneficiaries | 212 |
| Number Of Male Beneficiaries | 123 |
| Number Of Non Hispanic White Beneficiaries | 176 |
| Number Of Black or African American Beneficiaries | 105 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 41 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 210 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 125 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 21 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 47 |
| Percent Of With Chronic Kidney Disease | 40 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 42 |
| Percent Of With Diabetes | 49 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 56 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 52 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 11 |
| Average HCC Risk Score Of Beneficiaries | 2.1945 |