| National Provider Identifier [NPI]: | 1255458915 |
| Last Name Of The Provider | MONTAS |
| First Name Of The Provider | SACHA |
| Middle Initial Of The Provider | M |
| Credentials Of The Provider | MD |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1500 E MEDICAL CENTER DR |
| Street Address 2 Of The Provider | B1 FLOOR UNIVERSITY HOSPITAL RECP EMERGENCY |
| City Of The Provider | ANN ARBOR |
| Zip Code Of The Provider | 481095301 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Emergency Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 39 |
| Number Of Services | 919 |
| Number Of Medicare Beneficiaries | 672 |
| Total Submitted Charge Amount | 377008 |
| Total Medicare Allowed Amount | 106155.08 |
| Total Medicare Payment Amount | 82131.87 |
| Total Medicare Standardized Payment Amount | 80218.67 |
| 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 | 39 |
| Number Of Medical Services | 919 |
| Number Of Medicare Beneficiaries With Medical Services | 672 |
| Total Medical Submitted Charge Amount | 377008 |
| Total Medical Medicare Allowed Amount | 106155.08 |
| Total Medical Medicare Payment Amount | 82131.87 |
| Total Medical Medicare Standardized Payment Amount | 80218.67 |
| Average Age Of Beneficiaries | 63 |
| Number Of Beneficiaries Age Less65 | 316 |
| Number Of Beneficiaries Age 65 to 74 | 163 |
| Number Of Beneficiaries Age 75 to 84 | 122 |
| Number Of Beneficiaries Age Greater 84 | 71 |
| Number Of Female Beneficiaries | 365 |
| Number Of Male Beneficiaries | 307 |
| Number Of Non Hispanic White Beneficiaries | 412 |
| Number Of Black or African American Beneficiaries | 218 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 21 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 342 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 330 |
| Percent Of With Atrial Fibrillation | 16 |
| Percent Of With Alzheimers Disease or Dementia | 17 |
| Percent Of With Asthma | 19 |
| Percent Of With Cancer | 11 |
| Percent Of With Heart Failure | 40 |
| Percent Of With Chronic Kidney Disease | 44 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 33 |
| Percent Of With Depression | 48 |
| Percent Of With Diabetes | 47 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 54 |
| Percent Of With Osteoporosis | 9 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 45 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 14 |
| Percent Of With Stroke | 14 |
| Average HCC Risk Score Of Beneficiaries | 2.5853 |