| National Provider Identifier [NPI]: | 1205824265 |
| Last Name Of The Provider | GRISSOM |
| First Name Of The Provider | SAMUEL |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1350 E WOODROW WILSON AVE |
| Street Address 2 Of The Provider | METHODIST REHABILITATION CENTER |
| City Of The Provider | JACKSON |
| Zip Code Of The Provider | 392165112 |
| State Code Of The Provider | MS |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Physical Medicine and Rehabilitation |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 11 |
| Number Of Services | 3550 |
| Number Of Medicare Beneficiaries | 504 |
| Total Submitted Charge Amount | 399870 |
| Total Medicare Allowed Amount | 263955.55 |
| Total Medicare Payment Amount | 204116.83 |
| Total Medicare Standardized Payment Amount | 216855.64 |
| 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 | 11 |
| Number Of Medical Services | 3550 |
| Number Of Medicare Beneficiaries With Medical Services | 504 |
| Total Medical Submitted Charge Amount | 399870 |
| Total Medical Medicare Allowed Amount | 263955.55 |
| Total Medical Medicare Payment Amount | 204116.83 |
| Total Medical Medicare Standardized Payment Amount | 216855.64 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 101 |
| Number Of Beneficiaries Age 65 to 74 | 168 |
| Number Of Beneficiaries Age 75 to 84 | 137 |
| Number Of Beneficiaries Age Greater 84 | 98 |
| Number Of Female Beneficiaries | 287 |
| Number Of Male Beneficiaries | 217 |
| Number Of Non Hispanic White Beneficiaries | 346 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 358 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 146 |
| Percent Of With Atrial Fibrillation | 18 |
| Percent Of With Alzheimers Disease or Dementia | 16 |
| Percent Of With Asthma | 9 |
| Percent Of With Cancer | 15 |
| Percent Of With Heart Failure | 37 |
| Percent Of With Chronic Kidney Disease | 32 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 21 |
| Percent Of With Depression | 49 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 65 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 45 |
| Percent Of With Osteoporosis | 22 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 63 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 9 |
| Percent Of With Stroke | 30 |
| Average HCC Risk Score Of Beneficiaries | 1.4353 |