| National Provider Identifier [NPI]: | 1083617310 |
| Last Name Of The Provider | HALTER |
| First Name Of The Provider | DALE |
| Middle Initial Of The Provider | G |
| Credentials Of The Provider | M.D. |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 902 FROSTWOOD DR |
| Street Address 2 Of The Provider | STE 208 |
| City Of The Provider | HOUSTON |
| Zip Code Of The Provider | 770242426 |
| State Code Of The Provider | TX |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Internal Medicine |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 49 |
| Number Of Services | 54212 |
| Number Of Medicare Beneficiaries | 653 |
| Total Submitted Charge Amount | 1025866.87 |
| Total Medicare Allowed Amount | 688952.86 |
| Total Medicare Payment Amount | 521347.29 |
| Total Medicare Standardized Payment Amount | 522531.91 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 13 |
| Number Of Drug Services | 50454 |
| Number Of Medicare Beneficiaries With Drug Services | 235 |
| Total Drug Submitted ChargeAmount | 727128 |
| Total Drug Medicare AllowedAmount | 473571.06 |
| Total Drug Medicare PaymentAmount | 369141.04 |
| Total Drug Medicare Standardized Payment Amount | 369141.04 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 36 |
| Number Of Medical Services | 3758 |
| Number Of Medicare Beneficiaries With Medical Services | 653 |
| Total Medical Submitted Charge Amount | 298738.87 |
| Total Medical Medicare Allowed Amount | 215381.8 |
| Total Medical Medicare Payment Amount | 152206.25 |
| Total Medical Medicare Standardized Payment Amount | 153390.87 |
| Average Age Of Beneficiaries | 78 |
| Number Of Beneficiaries Age Less65 | 20 |
| Number Of Beneficiaries Age 65 to 74 | 208 |
| Number Of Beneficiaries Age 75 to 84 | 294 |
| Number Of Beneficiaries Age Greater 84 | 131 |
| Number Of Female Beneficiaries | 473 |
| Number Of Male Beneficiaries | 180 |
| Number Of Non Hispanic White Beneficiaries | 592 |
| Number Of Black or African American Beneficiaries | 16 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | 25 |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 636 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | 13 |
| Percent Of With Alzheimers Disease or Dementia | 11 |
| Percent Of With Asthma | 8 |
| Percent Of With Cancer | 9 |
| Percent Of With Heart Failure | 18 |
| Percent Of With Chronic Kidney Disease | 21 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 11 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 20 |
| Percent Of With Hyperlipidemia | 52 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 18 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 69 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 2 |
| Percent Of With Stroke | 9 |
| Average HCC Risk Score Of Beneficiaries | 1.26 |