| National Provider Identifier [NPI]: | 1194712471 |
| Last Name Of The Provider | DOMAN |
| First Name Of The Provider | DANIEL |
| Middle Initial Of The Provider | R |
| Credentials Of The Provider | DO |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 501 E CUMMINS ST |
| Street Address 2 Of The Provider | |
| City Of The Provider | TECUMSEH |
| Zip Code Of The Provider | 492862070 |
| State Code Of The Provider | MI |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Family Practice |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 69 |
| Number Of Services | 4342 |
| Number Of Medicare Beneficiaries | 657 |
| Total Submitted Charge Amount | 432525.76 |
| Total Medicare Allowed Amount | 275829.62 |
| Total Medicare Payment Amount | 188411.59 |
| Total Medicare Standardized Payment Amount | 198022.23 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 10 |
| Number Of Drug Services | 452 |
| Number Of Medicare Beneficiaries With Drug Services | 175 |
| Total Drug Submitted ChargeAmount | 20966 |
| Total Drug Medicare AllowedAmount | 11027.02 |
| Total Drug Medicare PaymentAmount | 9390.42 |
| Total Drug Medicare Standardized Payment Amount | 9390.42 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 59 |
| Number Of Medical Services | 3890 |
| Number Of Medicare Beneficiaries With Medical Services | 656 |
| Total Medical Submitted Charge Amount | 411559.76 |
| Total Medical Medicare Allowed Amount | 264802.6 |
| Total Medical Medicare Payment Amount | 179021.17 |
| Total Medical Medicare Standardized Payment Amount | 188631.81 |
| Average Age Of Beneficiaries | 74 |
| Number Of Beneficiaries Age Less65 | 117 |
| Number Of Beneficiaries Age 65 to 74 | 214 |
| Number Of Beneficiaries Age 75 to 84 | 190 |
| Number Of Beneficiaries Age Greater 84 | 136 |
| Number Of Female Beneficiaries | 343 |
| Number Of Male Beneficiaries | 314 |
| Number Of Non Hispanic White Beneficiaries | 621 |
| 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 | 511 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 146 |
| Percent Of With Atrial Fibrillation | 11 |
| Percent Of With Alzheimers Disease or Dementia | 21 |
| Percent Of With Asthma | 6 |
| Percent Of With Cancer | 6 |
| Percent Of With Heart Failure | 22 |
| Percent Of With Chronic Kidney Disease | 24 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 22 |
| Percent Of With Depression | 24 |
| Percent Of With Diabetes | 37 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 68 |
| Percent Of With Ischemic Heart Disease | 37 |
| Percent Of With Osteoporosis | 7 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 39 |
| Percent Of With Schizophrenia Other PsychoticDisorders | 8 |
| Percent Of With Stroke | 5 |
| Average HCC Risk Score Of Beneficiaries | 1.2938 |