| National Provider Identifier [NPI]: | 1285742312 |
| Last Name Of The Provider | DOMINIC |
| First Name Of The Provider | SUSAN |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | F |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 7780 N FRESNO ST |
| Street Address 2 Of The Provider | STE. 100 |
| City Of The Provider | FRESNO |
| Zip Code Of The Provider | 937202413 |
| State Code Of The Provider | CA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 57 |
| Number Of Services | 507 |
| Number Of Medicare Beneficiaries | 129 |
| Total Submitted Charge Amount | 72600 |
| Total Medicare Allowed Amount | 45309.74 |
| Total Medicare Payment Amount | 35225.58 |
| Total Medicare Standardized Payment Amount | 34260.82 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 5 |
| Number Of Drug Services | 32 |
| Number Of Medicare Beneficiaries With Drug Services | 12 |
| Total Drug Submitted ChargeAmount | 620 |
| Total Drug Medicare AllowedAmount | 146.31 |
| Total Drug Medicare PaymentAmount | 130 |
| Total Drug Medicare Standardized Payment Amount | 130 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 52 |
| Number Of Medical Services | 475 |
| Number Of Medicare Beneficiaries With Medical Services | 129 |
| Total Medical Submitted Charge Amount | 71980 |
| Total Medical Medicare Allowed Amount | 45163.43 |
| Total Medical Medicare Payment Amount | 35095.58 |
| Total Medical Medicare Standardized Payment Amount | 34130.82 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | |
| Number Of Beneficiaries Age 65 to 74 | 65 |
| Number Of Beneficiaries Age 75 to 84 | 36 |
| Number Of Beneficiaries Age Greater 84 | |
| Number Of Female Beneficiaries | 88 |
| Number Of Male Beneficiaries | 41 |
| Number Of Non Hispanic White Beneficiaries | 96 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 16 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 114 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 15 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 16 |
| Percent Of With Diabetes | 34 |
| Percent Of With Hyperlipidemia | 66 |
| Percent Of With Hypertension | 75 |
| Percent Of With Ischemic Heart Disease | 27 |
| Percent Of With Osteoporosis | 16 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 41 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.0551 |