| National Provider Identifier [NPI]: | 1114912037 |
| Last Name Of The Provider | SALLIS |
| First Name Of The Provider | MILTON |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 378 DINSMOOR DR |
| Street Address 2 Of The Provider | CHESTERFIELD |
| City Of The Provider | CHESTERFIELD |
| Zip Code Of The Provider | 630172956 |
| State Code Of The Provider | MO |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 43 |
| Number Of Services | 2307 |
| Number Of Medicare Beneficiaries | 1285 |
| Total Submitted Charge Amount | 2649521 |
| Total Medicare Allowed Amount | 291041.4 |
| Total Medicare Payment Amount | 223370.05 |
| Total Medicare Standardized Payment Amount | 224055.31 |
| 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 | 43 |
| Number Of Medical Services | 2307 |
| Number Of Medicare Beneficiaries With Medical Services | 1285 |
| Total Medical Submitted Charge Amount | 2649521 |
| Total Medical Medicare Allowed Amount | 291041.4 |
| Total Medical Medicare Payment Amount | 223370.05 |
| Total Medical Medicare Standardized Payment Amount | 224055.31 |
| Average Age Of Beneficiaries | 69 |
| Number Of Beneficiaries Age Less65 | 446 |
| Number Of Beneficiaries Age 65 to 74 | 319 |
| Number Of Beneficiaries Age 75 to 84 | 274 |
| Number Of Beneficiaries Age Greater 84 | 246 |
| Number Of Female Beneficiaries | 761 |
| Number Of Male Beneficiaries | 524 |
| Number Of Non Hispanic White Beneficiaries | 716 |
| Number Of Black or African American Beneficiaries | 538 |
| Number Of AsianPacific Islander Beneficiaries | 17 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 717 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 568 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 27 |
| Percent Of With Asthma | 17 |
| Percent Of With Cancer | 13 |
| Percent Of With Heart Failure | 42 |
| Percent Of With Chronic Kidney Disease | 46 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 31 |
| Percent Of With Depression | 47 |
| Percent Of With Diabetes | 48 |
| Percent Of With Hyperlipidemia | 60 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 52 |
| Percent Of With Osteoporosis | 11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 17 |
| Percent Of With Stroke | 13 |
| Average HCC Risk Score Of Beneficiaries | 2.6027 |