| National Provider Identifier [NPI]: | 1922259928 |
| Last Name Of The Provider | LEE |
| First Name Of The Provider | TSE |
| Middle Initial Of The Provider | C |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1671 N CLYDE MORRIS BLVD |
| Street Address 2 Of The Provider | SUITE 100 |
| City Of The Provider | DAYTONA BEACH |
| Zip Code Of The Provider | 32117 |
| State Code Of The Provider | FL |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Interventional Pain Management |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 66 |
| Number Of Services | 14854 |
| Number Of Medicare Beneficiaries | 535 |
| Total Submitted Charge Amount | 984598.98 |
| Total Medicare Allowed Amount | 538306.83 |
| Total Medicare Payment Amount | 421929.83 |
| Total Medicare Standardized Payment Amount | 386955.95 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 6766 |
| Number Of Medicare Beneficiaries With Drug Services | 261 |
| Total Drug Submitted ChargeAmount | 32092 |
| Total Drug Medicare AllowedAmount | 13190.98 |
| Total Drug Medicare PaymentAmount | 10265.58 |
| Total Drug Medicare Standardized Payment Amount | 10265.58 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 63 |
| Number Of Medical Services | 8088 |
| Number Of Medicare Beneficiaries With Medical Services | 535 |
| Total Medical Submitted Charge Amount | 952506.98 |
| Total Medical Medicare Allowed Amount | 525115.85 |
| Total Medical Medicare Payment Amount | 411664.25 |
| Total Medical Medicare Standardized Payment Amount | 376690.37 |
| Average Age Of Beneficiaries | 67 |
| Number Of Beneficiaries Age Less65 | 201 |
| Number Of Beneficiaries Age 65 to 74 | 182 |
| Number Of Beneficiaries Age 75 to 84 | 121 |
| Number Of Beneficiaries Age Greater 84 | 31 |
| Number Of Female Beneficiaries | 322 |
| Number Of Male Beneficiaries | 213 |
| Number Of Non Hispanic White Beneficiaries | 466 |
| Number Of Black or African American Beneficiaries | 27 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 31 |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 350 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 185 |
| Percent Of With Atrial Fibrillation | 9 |
| Percent Of With Alzheimers Disease or Dementia | 10 |
| Percent Of With Asthma | 13 |
| Percent Of With Cancer | 7 |
| Percent Of With Heart Failure | 19 |
| Percent Of With Chronic Kidney Disease | 25 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 30 |
| Percent Of With Depression | 43 |
| Percent Of With Diabetes | 36 |
| Percent Of With Hyperlipidemia | 64 |
| Percent Of With Hypertension | 73 |
| Percent Of With Ischemic Heart Disease | 41 |
| Percent Of With Osteoporosis | 14 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 75 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 7 |
| Percent Of With Stroke | 7 |
| Average HCC Risk Score Of Beneficiaries | 1.6304 |